Provider Update Newsletter

Welcome to the May 2023 Provider Update Newsletter

May 25, 2023

 

Next Gen Contract

Important reminder: update addresses and affiliations in the Provider Network Management module

Please update and maintain all addresses and practitioner affiliations in the Provider Network Management (PNM) module on a regular basis to keep all information current. This information is required by the provider agreement. See details and instructions.

 

Announcements

 

Update to Claims Unbundling Edits effective July 2023

Buckeye Health Plan's Payment Integrity department is implementing changes to the suite of unbundling edits with enhanced business rules to improve customer experience. Providers may see a reduction in…

 

Medicare Part B Drug List and Prior Authorization Updates effective 7-1-23

Medicare Appendix A Part B Drug List Effective 7-1-23

Medicare CNC Prior Authorizations Effective 7-1-23

 

Use Modifier 33 for Full Reimbursement for Filing the ePRAF Effective 7-1-23

Effective July 1, 2023, Buckeye Health Plan will follow ODM guidance requiring use of 33 Modifier for the full reimbursement for filing the ePRAF.  See details.

 

Medicare & Marketplace Policy Updates Effective 7-1-23

As you know, we continually review and update our payment and utilization policies to ensure that they are designed to comply with industry standards while delivering the best patient experience to our members. See the revisions to existing Medicare and Marketplace policies effective 7-1-23. 

 

For Your Information

 

Provider Satisfaction is Essential

Buckeye Health Plan will once again canvass a random sample of providers from across the state to measure your satisfaction with us and several areas within Buckeye. If selected, we ask that you take time to provide feedback. We truly value your input and use that information to make us better able to deliver for you and your patients. We anticipate the survey to launch in the latter half of June. 

 

Epic Payer Program

As part of our broader interoperability strategy, we are participating in Epic Payer Platform, a platform that enables more secure, efficient bi-directional data exchange between providers and health plans. See details and how to learn more.

 

New Education Website Page

We have built a new Education website page to house various items that we feel you would benefit from gaining additional understanding. Check out the helpful, new Preventive Care and Modifier -25 items recently added.

 

A ‘CPC In the Future’ Event on June 1!

Ohio Department of Medicaid will be hosting an opportunity to offer input and feedback on proposed updates to the CPC program administrative code rules (OAC 5160-19-01 and -02). Learn more details and register.

 

Upcoming Portal Enhancements and Survey

We want to provide you with a heads up on upcoming enhancements to the Provider Portal Landing Page and a Pop-Up Survey you may encounter on the portal toward the end of June. See a list of enhancements you can expect.

 

Training and Education

 

Webinar Wednesdays With Payspan

Payspan hosts monthly provider training sessions. Webinar Wednesday sessions are open to any provider and payer representative who would like to learn more about the provider experience on the payspanhealth.com portals. See the details on what is covered and register.

 

New BH HEDIS Training Module now Available

Strategies to Minimize the Risk of Opioid Overuse and Misuse

Optimizing the Impact of the Opioid related POD, COU, UOP and HDO HEDIS Measurements

 

Feature Article

Buckeye Partners with 'This Is Quitting' to Combat Teen Vaping

E-cigarettes have become the most common form of tobacco products for middle and high school students in Ohio. A recent study found that 11.9% of middle school and 29.0% of high school students use e-cigarettes. To combat the growing trend, Buckeye has partnered with ‘This is Quitting’ to provide a free, app-based support tool for youth to quit. See the details.

 

Behavioral Health

Mental Health Awareness Month

Buckeye Health is aiming to raise the collective mental health IQ in our communities to help reduce fear, shame and stigma that is often associated with mental illness.  See how the CDC defines mental health and details to get help.

Welcome to the April 2023 Provider Update Newsletter

April 27, 2023

 

Next Generation Contract

Who to Bill for Physical Health Services from OhioRISE

Since its July 2022 launch, nearly 20,000 children have been enrolled into OhioRISE behavioral health supports as well as Ohio Medicaid’s traditional physical health services. If you are a provider supporting OhioRISE enrollees, we want to ensure you know who to bill for the non-behavioral health services they receive.

Medicaid Providers Note:

We identified an issue where 835 files from Buckeye were not being received by OMES; therefore 835 files sent between February 1 to March 20, 2023, may be reprocessed which could cause duplication. Please make staff aware of this possibility to ensure the file is not posted a second time. If you have any questions, please reach out to Provider Services at 866-296-8731. We apologize for any inconvenience this may cause and thank you in advance for your understanding.

Feature Article

New care coordination roles help members

With the launch of Next Generation managed care plans offer more care coordination services to help members navigate their care. More services means additional specialized staff support, including four care coordination roles: care manager, care manager +, care guide, and care guide +. See more details.

Announcements

Changes to managed care claims submitted via the EDI

MCOs have been instructed to reject claims received for Medicaid members for DOS on or after 2/1/23 that were received by the MCO and not sent through the OMES Fiscal Intermediary…

Office Manager Forum
Join us for one of our Office Manager Forums: Making it Easier to Do Business with Buckeye. After a long break due to the pandemic, Buckeye Health Plan is excited to once again speak with you 1:1 and collect your feedback. Review the schedule and RSVP for one that best fits your schedule. 

For Your Information

Phase 1 of Prepayment Claim Reviews

On March 27, 2023, we notified you that we will begin performing additional prepayment claim reviews on July 1, 2023. For Phase 1, claims received on or after July 1, 2023, providers may experience a slight increase in written requests for medical record submission prior to payment for Custom Fitted or Custom Fabricated Prosthetics or Orthotics. We will be requesting medical records to verify…

Healthchek School-Based Services Available Throughout Ohio

The Ohio Department of Medicaid and Buckeye Health Plan encourage the use of school-based services to ensure students are healthy and engaged, which enables a better overall learning experience.

School-based health in Ohio ranges from large school health centers that houses full-time medical staff to smaller, part-time clinics that may only have one staff member. Services include…

Pharmacy

Improve Medication Adherence with Listening and Understanding

We all know the importance of medication adherence and how that alone can have more of an impact on health outcomes than the specific treatment itself. The most important thing you can do is to listen to patients and truly understand the barriers they are having. See more details and tips.

Behavioral Health

April is National Stress Awareness Month

Stress Awareness Month has been observed since 1992. Stress can be thought of as physical, emotional, or mental strain or tension. Often all three of these types of strain occur simultaneously. People are reporting increased stress due to many reasons. See the details.

Reminders

Are you aware of our METS Program?

Members Empowered to Succeed (METS) is a Behavioral Health clinical program within Buckeye Health Plan that has been successfully supporting Ohio providers and members for two years. It is a unique approach to member care focusing on the individualized needs to create a recovery roadmap that is personalized to the member. Read more details about the successful program and how it can assist you.

End Date of Public Health Emergency (PHE) and PASRR Impact

In March 2020, the Ohio Department of Medicaid (ODM) made a number of operational changes to its Medicaid program in response to the COVID-19 public health emergency (PHE). As of May 12, 2023, As such, the Center for Medicare and Medicaid Services expect states to resume full…

Professional Opportunities

Suicide Prevention Training – Free – July 11

As we continue our collaboration with the Association of Clinicians for the Underserved (ACU), we have another opportunity for our network providers for a virtual suicide prevention training at no cost. See details and registration.

Diabetes during Pregnancy and Postpartum

Weitzman ECHO Series for Ohio: Diabetes Across the Lifespan
New module launches May 2, 2023
Sessions occur every 1st and 3rd Tuesday from 12pm to 1pm ET

At each session, these Ohio-based multidisciplinary experts offer guidance to improve health outcomes for pregnant and postpartum patients, help patients navigate services to address barriers to postpartum care, and treat diabetes complications and co-morbidities more effectively in primary care. See more details and registration.

Welcome to the March 2023 Provider Update Newsletter

March 28, 2023

 

Next Generation Contract

ODM has determined the direct submission of claims by trading partners to MCEs is no longer needed
Based on recent trends with successful transmission rates, ODM has determined the direct submission of claims by trading partners to MCEs is no longer needed and would create…

OhioRISE: Prior Authorization for Inpatient Hospital Admissions
An inpatient hospital admission with a primary diagnosis of mental illness or substance use disorder (SUD) results in enrollment in the Ohio Resilience through Integrated Systems and Excellence (OhioRISE) program for individuals under 21 years of age. The process to get an approval for this service may cause confusion with providers. To help reduce confusion for the provider…

 

Behavioral Health

Feature Article: HEDIS Follow-up after Hospitalization for Mental Illness
Healthcare Effectiveness Data and Information Set (HEDIS) is one of healthcare’s most widely used performance improvement tools. They help set a benchmark for American healthcare consumers to review when choosing providers. Follow-Up After Hospitalization for Mental Illness (FUH) assesses the percentage of inpatient discharges for a diagnosis of mental illness or intentional self-harm among patients aged six years and older that resulted in follow-up care with a mental health provider within 7 and 30 days. See more details and tips.

 

Reminders

HEDIS BH Training
If you haven’t yet, be sure to take advantage of the HEDIS Behavioral Health Training available on our Training website page. Some of the many benefits from these trainings include:

• Focusing on quality outcomes can help patients get the most from their benefits, which ultimately means better use of limited resources
• In addition to better care for patients, addressed caps in care, etc.
• Provide strategies to positively impact quality care, outcomes and member experience
• Assist in recognizing the intent of the Behavioral Health HEDIS measures
• Those in P4P VBCs could increase their quality bonus payouts with more knowledge/ awareness around the measures.

 

Professional Opportunities

Virtual Roundtables: Improving Outcomes for People with Disabilities
The OAHP and OCALI are providing an outstanding opportunity to deepen your understanding of people with disabilities and population health. The one-hour ‘Improving Outcomes for People with Disabilities’ virtual roundtables include lived experience, didactic presentation and opportunity for interaction. Each session is designed to challenge your thinking, change your practice, and provide you with resources. Special attention will be paid to topics such as intersectionality and equity. For the Roundtable’s schedule and more details please see our Professional Opportunities page of our website.

 

For Your Information

Provider Services Helpful FAQs
Do you have questions regarding how to interact with Buckeye under the new Next Gen Contract? To assist, we’ve shared some of our most frequently asked question and answers on our Next Gen Contract Information website page.

Medicaid Revalidation Scam Alert
The Ohio Department of Medicaid (ODM) has been made aware of a current scam, where callers are stating the member will lose Medicaid coverage if the member doesn’t pay hundreds of dollars to the scammer. See more details.

 

Announcements

Optum CPI Amysis Overview
We are committed to continuously improving our overall payment integrity solutions to prevent overpayments due to waste or abuse. This is a notification that we will begin performing additional prepayment claim reviews on July 1, 2023, using Optum’s Comprehensive Payment Integrity (CPI) tool. As a result of these prepayments…

ODM Provider Agreement Revalidations Pause: ODM paused provider agreement revalidations/recredentialing by pushing out all pending provider revalidation due dates in the Provider Network Management (PNM) module by 180 days. Dates were pushed out in the system during the week of February 6, 2023.  The updated due dates applied to…

Behavioral Health Prior Authorization Update
Effective immediately, we are no longer requiring a prior authorization for Assertive Community Treatment (ACT) Services CPT code H0040 for the initial 12 months. After 12 months, providers will submit a prior authorization for a medical necessity review.

Prior Authorization Updates – See Details

• Supplies, Continuous Glucose Monitoring
• Receiver/Monitor, Continuous Glucose Monitor
• External Transmitter
• External Receiver/Monitor

 

Welcome to the February 2023 Provider Update Newsletter

February 28, 2023

 

Next Generation Contract

A message from ODM: Claim submission and adjudication reminders

The transition of the new Electronic Data Interchange (EDI) along with the Fiscal Intermediary (FI) as part of the Next Generation of Ohio Medicaid program on February 1 has adjusted how you submit and access claims. ODM has provided guidance.  

 

Policy Updates

We have made changes and retired several policies effective April 1, 2023. Please see our latest Policy Updates!

 

Feature Article

Behavioral Health: Social Isolation vs Loneliness

Learn the difference between Social Isolation and Loneliness, how to recognize it, health risks, high-risk immigrant, and LGBTQ community and how to help.

 

Announcements

Prior Authorizations: See what we’ve removed, changed and added effective April 1, 2023.

New Coding Changes: Changes to Inappropriate Primary Diagnosis and Interim Claims effective April 1, 2023

Provider Engagement Administrators: in our ongoing efforts to maintain a strong partnership with our providers, we’ve refocused the role of our Provider Relations Representative. Moving forward, this role will be titled Provider Engagement Administrator (PEA). See more information and the website page to find your assigned PEA.

Helpful FAQs: Do you have questions regarding how to interact with Buckeye under the new Next Gen Contract? To assist, we’ve shared some of our most frequently asked question and answers on our Next Gen Contract Information website page.

 

FYI

Do You Need Assistance Talking to Your Patients about Redetermination/Medicaid Eligibility Renewal?

We’ve provided talking points and fliers to assist you in discussing options if your patients are no longer are eligible for Medicaid.

Are you aware of our METS Program?

Members Empowered to Succeed (METS) is a Behavioral Health clinical program within Buckeye Health Plan that has been successfully supporting Ohio providers and members for two years. It is a unique approach to member care focusing on the individualized needs to create a recovery roadmap that is personalized to the member. Read more details about the successful program and how it can assist you.

Preventive Health & Clinical Guidelines – Our latest Guidelines have been posted to the website.

RxEffect: Great news! RxEffect opportunities are uploaded in the RxEffect platform as of January 12^th. Log in today to help your patients start the year off strong with medication adherence and gap closure!

 

Professional Opportunities

2023 CDI Webinar Schedule

Centene is offering a comprehensive catalog of Risk Adjustment Documentation and Coding. Each webinar includes an overview of Risk Adjustment (RA) and Hierarchical Condition Categories (HCCs).  Select a webinar, the date, and register.

Welcome to the January 2023 Provider Update Newsletter

January 31, 2023

 

A Message from our CEO

Happy New Year!

Buckeye Health Plan deeply values your partnership and commitment to supporting our members’ healthcare needs. Our goal is to continue to build our trusting relationship with you and our members. We have exciting new tools and options available to you in 2023 that make working with Buckeye even easier.

• Tools and resources are in place to implement Ohio Medicaid’s Next Generation Medicaid Managed Care Plan Contract that goes live February 1.
• Buckeye has expanded our Medicare and Marketplace plans into more counties.
• Buckeye is launching a new level of care and service to our members though Care Guides. These professionals will provide a personalized approach to guide members through short-term or one-time service needs such as help finding a PCP or accessing services and resources. Our Care Managers will continue to focus on members’ healthcare needs for hospitalization and services for conditions such as, asthma, diabetes, COPD, and high-risk pregnancy. 

Please take a moment to see a brief overview video that highlights some of what’s next!  

 

Next Generation Contract

Next Gen Policies Website Page: To make things easier as we transition into the Next Generation contract, we have posted all the ODM-Approved Clinical, Pharmacy and Behavioral Health policies on a special Next Gen Policies page.

Orientation Training & Attestation Requirement: take our required Orientation Training for the Next Gen February 1 Launch and be sure to complete the attestation when complete.

New Dispute-Appeals section of the website: in an effort to make working with us easier, we’ve laid out the new Medicaid/Next Gen Dispute-Appeals section of the website.

 

Announcements

Introducing our new Care Guides supporting members

• The MCO Care Guide and Care Guide + serves as a single point of contact for care coordination for short-term care coordination needs
• Care Guides typically provide assistance for 60 days or shorter. Members needing Care Guide assistance for longer than 60 calendar days should be considered for referral to a Care Manager.
• Care guides assist members and providers with things such as, DME, Coordinating PCP and Specialist visits, housing, transportation and more. Watch a brief video about How Care Guides Can Help and read all the details.

 

Reminder

New Provider Service Hours
To align with the new ODM Next Gen Medicaid contract, Buckeye’s Member and Provider Services hours of operation will change to Monday-Friday 7 a.m. to 8 p.m. (EST), beginning February 1, 2023. See our Provider Home Page for all product hours and service numbers.

 

Behavioral Health

Learn about Buckeye’s Peer Recovery Services

Peer Specialists focus on individual strengths and assets, they can help Buckeye members view their challenges as opportunities rather than defeats or failures. Empathy is at the core of this service, and it embodies the Buckeye way of “leading with heart.” See more details and resources.

Thrive Peer Recovery Services - Buckeye Member Testimonial

As part of Buckeye’s vision to transform the health of our community, one person at a time, Buckeye Health Plan aims to manage the most complex, vulnerable members which include members with chronic mental health and substance use disorders. One of our partners, Thrive Peer Recovery Services, utilizes mental health and substance use disorder peer support specialists to function as care extenders and engage members into treatment. Read our member’s testimonial.

 

Professional Opportunities

Weitzman ECHO Substance Use Disorders
Managing Patients with Substance Use Disorders in Primary Care

Kick-off Session:
Monday, February 13, 2023, from 12-1 PM ET
Sessions occur every 2nd and 4th Monday

See the details

Comprehensive Primary Care Quarterly Informational Series

The Ohio Department of Medicaid would like to invite you to the Comprehensive Primary Care (CPC) program year 2023’s quarterly informational meeting series. First one is February 14, 2023. See the dates, times and topics.

Welcome to the December 2022 Provider Update Newsletter

December 21, 2022

 

Next Generation Contract

What to Expect on February 1, 2023
See the message from ODM on the website for Phase 3 of the Next Generation contract.

How to prepare for EDI Claims-related Activities for February 1, 2023
On February 1, 2023, ODM will implement the new Electronic Data Interchange (EDI) module as part of the Next Generation program. The new EDI vendor is Deloitte and the EDI will be the exchange point for trading partners on all claims-related activities. To assist in preparations, ODM compiled a list of important changes to keep in mind.

As a result of feedback from MCEs and providers, OhioRISE Mixed Services Protocol Updated December 8, 2022

 

Behavioral Health

New Version of Behavioral Health Provider Manual
ODM has provided a new version of the BH Provider Manual as of January 1, 2023. You will find the Provider Manual here. 

Follow-Up Care for Children Prescribed ADHD Medication (ADD)
Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common behavioral health conditions diagnosed in childhood. A key component of effective treatment for ADHD is medication management. See more details and resources on our Behavioral Health Education website page.

“MITS BITS” Renamed “BH Bulletin
“MITS BITS” is being replaced with “BH Bulletin” as the newsletter to Medicaid behavioral health provider agencies and stakeholders. The BH Bulletin will continue to be an “as needed” communication vehicle offering updates, policy clarification, technical assistance, and useful news to community behavioral health agencies and other stakeholders. Current MITS BITS subscribers will automatically receive the new BH Bulletin. New subscriptions may be requested at BH.Medicaid.ohio.gov.

MITS Claims Payment Issue Resolved
ODM recently became aware of a MITS claims payment error that caused underpayments for some Medicaid service codes when a certain number of units were exceeded. This affected claims with dates of service on or after October 1, 2022. See the list of codes impacted.

Medicaid Payment Rates for CANS Assessments Will Increase January 1, 2023
Effective for dates of service January 1, 2023, and after, ODM will be increasing the payment rate for CANS assessments. The updated rates will be reflected in the revised Appendix to OAC rule 5160-27-03, the Medicaid Behavioral Health Provider Manual and the OhioRISE Provider Enrollment and Billing Guidance prior to January 1, 2023.

 

FYI

Updated Clinical Practice Guidelines are now available.

New Member Quick Guide
We are pleased to share we rolled out a new Member Quick Guide for our members that helps explain Buckeye member benefits like medical, dental and vision coverage, care coordination, My Health Pays rewards, transportation and more.

Tips for a Successful Medical Necessity Submission
In our ongoing effort to make working with Buckeye as easy as possible, we’ve provided tips to help make your submission successful.
 

Reminders

Cultural Competency Refresher
Improving and practicing cultural awareness, humility and mindfulness can help you better understand and respond to the needs of patients while maintaining a professional level of respect, objectivity, and identity. A Cultural Competency Video from the State Medical Board of Ohio is available to refresh your knowledge before the end of the year.

New Provider Service Hours
To align with the new ODM Next Gen Medicaid contract, Buckeye’s Member and Provider Services hours of operation will change to Monday-Friday 7 a.m. to 8 p.m. (EST), beginning February 1, 2023. See our Provider Home Page for all product hours and service numbers.

Holiday Hours
Buckeye Health Plan will be closed on Monday, December 26, 2022, and January 2, 2023, in observance of the holidays. Provider Home Page

Welcome to the November 2022 Provider Update Newsletter

November 28, 2022

Next Generation Contract

ODM has announced that the Phase 3 Launch of the Next Gen Contract has been delayed until February 1, 2023. Please see our Next Gen Contract Information page for details.
 

Announcements 

Medicare Prior Authorization List and Medicare Part B Drug List have been updated effective January 1, 2023.

2023 Medicare Product Updates
Starting in 2023, Wellcare by Allwell is expanding its selection of plans across Ohio.  

Effective January 1, 2023, Medicare fax attestations are no longer accepted:
Special Supplemental Benefits for Chronically Ill (SSBCI) are offered to Wellcare’s highest-risk members who meet specific criteria for eligibility based on the Centers for Medicare and Medicaid Services (CMS) guidelines. See details.

New Provider Service Hours
To align ourselves with the new ODM Next Gen Medicaid contract, Buckeye’s Member and Provider Services hours of operation will change to Monday-Friday 7 a.m. to 8 p.m. (EST) , beginning February 1, 2023. See our Provider Home Page for all product hours and service numbers.

Holiday Hours
Buckeye Health Plan will be closed on Monday, December 26, 2022, and January 2, 2023, in observance of the holidays. 
 

Behavioral Health

Metabolic monitoring for children and adolescents on antipsychotics
Antipsychotic medications can elevate a child’s risk of developing metabolic health complications and are associated with poor cardiometabolic outcomes in adulthood. See more details. 

New Training for BH HEDIS Measures
Several new on-demand training opportunities in support of behavioral health (BH) HEDIS measures are now available. These trainings allow Buckeye Health Plan to share strategies to positively impact quality care and outcomes for our members, as well as assist providers in recognizing the intent of the (BH) HEDIS measures and BH Experience of Care and Health Outcomes (ECHO) Survey. 
 

HEDIS

Pediatric BMI Measures - Message from Medical Director: Importance of Weight Assessment and Counseling for Nutrition and Physical Activity During Pediatric Well-checks
BHP Medical Director Peter J. Kambelos, M.D., F.A.C.P, emphasizes the importance of Weight Assessment and Counseling for Nutrition and Physical Activity during pediatric well-checks and, as a part of that well-check, including documentation and coding of the child’s BMI.
 

Professional Opportunity 

As Centene continues our collaboration with the Association of Clinicians for the Underserved (ACU), we have another opportunity for a virtual suicide prevention training at no cost. This upcoming Suicide Safer Care webinar, "Caring for the Healers Pt. III: Preventing Suicide in Healthcare Professionals & Staff and Navigating Postvention." will take place on December 8, 2022. Details and registration available through the link. ACU will also debut their new self-assessment for health centers and other organizations to help them better address suicide risk in healthcare professionals and respond effectively via postvention.

Welcome to the October 2022 Provider Update Newsletter 

October 28, 2022

 

Next Generation Contract

With much change and new processes to learn to stay on top of the Next Generation Medicaid Contract, we continue to assist you by making everything you need to know on our website.

• 12-1-22 Journey Maps - ODM has published helpful Journey Maps to help you understand and navigate the final Phase 3 rollout.
• New 12-1 Trainings – In preparation for the Phase 3 launch, ODM has made trainings available.
• October Launch – Full overview of what you need to know about the changes for Phase 2 of the Next Gen Contract.

Policy Update

As you know, we continually review and update our payment and utilization policies to ensure that they are designed to comply with industry standards while delivering the best patient experience to our members. We are informing you today of a new policy Buckeye Health Plan will be implementing effective 01/01/23

Pulmonary Function Testiing
CP.MP.242
Medicaid, Marketplace

Limits pulmonary function testing to members over the age of three and for medically necessary indications. For detailed information about this policy, please refer to our policy website page.

Announcements

• The Next Generation Medicaid Contract Provider Manual for 2022-23 is now available for your review.
• Compassionate Connections Program in Northeast Ohio 
  Partnering with Visiting Physicians Palliative Care, Buckeye is proud to share an exciting clinical program affectionately called Compassionate Connections. Compassionate Connections provides support to members with chronic illnesses that may need assistance with managing their health within their home and assists with filling care gaps. See the details of our unique program.
• New Appointing a Representative website page for Appeals – To make the process of appointing a representative for Appeals easier to follow, we’ve created a new website page located under our Appeals section of the website.

Behavioral Health

• ODM has recently published the latest Behavioral Health Provider Manual. You’ll find access to the manual in our Behavioral Health Latest News.
• Cardiovascular and Diabetes Metabolic Screenings for People with Schizophrenia or Bipolar Disorder
  Heart disease and diabetes are among the top 10 leading causes of death in the United States. Individuals with serious mental illness who take antipsychotics are at increased risk of cardiovascular diseases and diabetes. Screening and monitoring of these conditions is important. See the physical health screenings that are essential in improving health, quality of life and economic outcomes in the future.
• Changes Made to ICD-10 Code Groups as of 10-1-22
  Ohio Department of Medicaid has made updates to the ICD-10 Diagnosis (DX) Code Group resource file in response to the annual 2023 ICD-10 Update. See the edit tracker for detailed information on the DX code updates in our Latest Updates.

Feature Article

OhioRISE in Action

The Ohio Department of Medicaid (ODM) launched OhioRISE on July 1, 2022, as the first of three phases of the Next Generation of Ohio Medicaid. The program aims to shift the system of care and keep more kids and families together by creating new access to in-home and community-based services for children with the most complex behavioral health challenges. We are pleased to share a recent success story.

HEDIS

• Start Smart for Your Baby Offers Crucial Support, Results and Better Outcomes
  Our program provides a wide array of benefits to members, with additional interventions available to high-risk patients.
• Helping Buckeye Members Get the Care They Need 
  It is always a good time for preventative health. Buckeye is striving to ensure all members have the tools and resources they need to get healthy and remain healthy. By engaging members through various communication platforms, we are educating members on maintaining their health through annual well visits and screenings.
• Encouraging Flu Shots (CAHPS) Did you know your patients are likely to get a flu shot if you recommend it.  Flu prevention is more important than ever. We’ve shared helpful suggestions and talking points.

FYI 

• Provider Services Hours Changing: Beginning December 1, 2022, under the Next Generation of Managed Care, Buckeye’s Member and Provider Services hours of operation will change to Monday-Friday 7 a.m. to 8 p.m. (EST).
• Holiday Hours: Our Provider Services will be closed Thursday and Friday, November 24 and 25, 2022 in observance of the Thanksgiving holiday. Please let us know if you have any questions.
• ODM has published a new manual for Provider Billing and data exchange related instructions, policies, and resources. You will find it on the ODM website.
• Enrollment for the Comprehensive Maternal Care (CMC) alternative payment model program is open from October 10 to November 7. To participate, you must complete an enrollment in the Provider Network Management (PNM) module for the CMC program. See the more details here.

Professional Opportunities

• Caring for the Healers Part III: Preventing Suicide in Healthcare Professionals and Staff and Navigation Postvention
  As Centene continues our collaboration with the Association of Clinicians for the Underserved (ACU), we have another opportunity for your network providers for a virtual suicide prevention training at no cost. This upcoming Suicide Safer Care webinar, "Caring for the Healers Pt. III: Preventing Suicide in Healthcare Professionals & Staff and Navigating Postvention." will take place on December 8, 2022. Details and registration available through the link. ACU will also debut their new self-assessment for health centers and other organizations to help them better address suicide risk in healthcare professionals and respond effectively via postvention.
• Weitzman ECHO Series for Ohio: Diabetes Across the Lifespan
  Announcing a new Weitzman Institute ECHO series for Ohio providers: Diabetes Across the Lifespan, offered in collaboration with Buckeye Health Plan and Ohio University Heritage College of Osteopathic Medicine. Ohio-based SMEs will address patients’ complex health needs related to diabetes care using a multidisciplinary team approach, detailing care among aging adults, pregnancy and postpartum, adolescents, and pediatrics. This no-cost program began on October 18, but registration is still available for this 12-month program. See more details.

Welcome to the September 2022 Provider Update Newsletter 

September 28, 2022

 

Next Generation Contract

Get Your OH|ID by October 1! The first step needed to access new Medicaid Enterprise Systems.

On October 1, Medicaid providers will need a State of Ohio digital identification (OH|ID) to access the Provider Network Management (PNM) Module and Gainwell Technologies’ single pharmacy benefit manager (SPBM) secure provider portal. Click the link above to create an account through the State's login system. To understand why this is important and sources for assistance, please see our Update. 

Announcements

• New FAP website page: in our ongoing efforts to make doing business with Buckeye, we have restructured our Find-A-Provider website page to allow direct access to all our product provider searches from that page.
  
  
• New Provider Communication Sign-up Form Raffle: Congratulations! Our winner of a $1,000 Amazon E-Gift Card from our September 12 random drawing is a group office located in Erie County, Ohio.
  
  Be sure you submit your completed Sign-Up Form to be eligible for our next random drawing of a $1,000 Amazon E-Gift Card on October 17!
   

Feature Article

Suicide in Older Adults: Suicide is more than a preventable tragedy—it is a major public health problem affecting men and women of all ages. Among older adults in particular, suicide is a significant concern because while older adults include just 12% of the population, they make up approximately 18% of suicides.  Among people who attempt suicide, one in four seniors will succeed, compared to 1 in 200 youths.  In addition, men 65 and older face the highest overall rate of suicide. Look here for more stats, risk factors, warning signs and how to help.
 

Professional Opportunity

Weitzman ECHO Series for Ohio: Diabetes Across the Lifespan

Announcing a new Weitzman Institute ECHO series for Ohio providers: Diabetes Across the Lifespan, offered in collaboration with Buckeye Health Plan and Ohio University Heritage College of Osteopathic Medicine. Ohio-based SMEs will address patients’ complex health needs related to diabetes care using a multidisciplinary team approach, detailing care among aging adults, pregnancy and postpartum, adolescents, and pediatrics. This no-cost program begins October 18. See more details.

HEDIS

• Medicare: New Centene Medicare CPT II and HCPCS $0.01 Billing Program. Centene Medicare providers can now utilize the CPT II $0.01 Billing Program. The $0.01 Billing Program seeks to reimburse providers...

• New BH HEDIS Training: In our efforts to continue to make working with Buckeye easier, we now have a website page dedicated to Behavioral Health Training. Check out the various trainings and the HEDIS assistance they provide.
  
  Each month we will highlight one of our new BH HEDIS Trainings. This month we place a Spotlight on our AMM & SAA HEDIS measure
   
  
• Be sure you review the New 2022 HEDIS Provider Reference Guide located on our website.
  
  
• Quality Measures for Statin Therapies: Buckeye has put in place initiatives to improve our measures and the success of Buckeye Health Plan quality efforts. The quality care of the members we serve relies on each provider’s attention to these initiatives.
   
  
• Closing Gaps In Chronic Disease Management Through Teladoc® and Babylon:  In the early stages of the pandemic, it was widely agreed-upon that patients should only go to their provider’s office if absolutely necessary. But soon, that idea turned into a question for healthcare providers. Is there a way to provide some of the assistance a patient could get from urgent care in their own home? Centene found a solution.

 

For Your Information

• The AAP Foundation Fundraiser Luncheon: From Fear to Medical Freedom- Overcoming the Vaccine Hesitancy Movement and Medical Misinformation to Increase Rates Through Pediatricians, Legislators, Media, and the Community is being held on October 28, 2022, at 11:30 am at the Polaris Hilton. All funds raised go to…
   
  
• Medicare: Reminder to Update and Certify Provider Information NPPES

As a valued provider partner, we’d like to remind you to review your National Provider Identifier (NPI) data in National Plan & Provider Enumeration System (NPPES) as soon as possible to ensure that accurate provider data is displayed.  As you may know, providers are legally required to keep their NPPES data current. See more details.

• Our annual Provider Satisfaction Survey was sent to a random sample of network providers by our partner, SPH Analytics.  If you were selected to participate, we hope you will provide your valuable feedback to help us make impactful changes that reduce your administrative burden and make it easier to do business with Buckeye. 

Welcome to the August 2022 Provider Update Newsletter 

August 26, 2022

 

Next Generation Contract

Provider Network Management (PNM) Pre-Registration Tool is Live

Single Pharmacy Benefit Manager SPBM - New website page and ODM announces training

OhioRISE Provider Enrollment During System Transition

   

Announcements

New website pages:

• Fraud, Waste and Abuse - new page and ODM training
• New Training and Education Section of the Website 
• Welcome New Providers 
• Non-Participating Providers 
• Single Pharmacy Benefit Manager (SPBM)
• Electronic Visit Verification (EVV)

Medicare: Updates to Claim XTen

Provider Advisory Council Expansion

Feature Articles

Behavioral Health: September is Suicide Awareness Month

Start Smart for Your Baby® Offers Crucial Support, Results and Better Outcomes

 

Policy Updates

Clinical Policy Updates effective November 1, 2022

• EEG for Headache
• ADHD Testing and Treatment
• Testing for Select Genitourinary Conditions

Medicare: PA Change to Wound Care Effective October 1, 2022 

 

FYI

Professional Opportunities

• Webinar: How Primary Care Providers Can Help Prevent Elder Suicide: A New Guide to Geriatric Suicide Safer Care
  Tuesday, September 27, 2022: 1-2 p.m. ET
  See the details
  
  
• Value-Based Care & Behavioral Health: A Provider's Perspective
  September 14, 2022  1-2:00 p.m. EST
  Join this webinar to learn more about the benefits and share your thoughts about Value-Based Care & Behavioral Health.

RxEffect Testimonials 

CPC MITS Update 

Updated Preventive Health and Clinical Practice Guidelines

New Behavioral Health MicroLearning – SUD & Physical Health Comorbidities 

New Electronic Visit Verification (EVV) Alt EVV Specifications and August 30 webinar    

 

Welcome to the July 2022 Provider Update Newsletter 

July 28, 2022

 

Next Generation Contract

Provider Enrollment and Maintenance Update

Beginning Aug. 1, the Ohio Department of Medicaid (ODM) will temporarily stop accepting provider enrollment applications as we transition to the new Provider Network Management (PNM) module. New providers should enroll by July 31 or…

Registration is open for Provider Network Management (PNM) Training!

Ohio Medicaid is in the process of implementing our Next Generation program to focus on the individual rather than the business of managed care so that we can do better for the people we serve. One way we hope to achieve this vision is through the implementation of the Provider Network Management (PNM) module to reduce the administrative burden on providers.

OhioRISE Update Mixed Services Protocol

Submitting claims to Aetna OhioRISE for RISE covered services, and all other services to Buckeye,  Mixed Services Protocol documentation should be referenced.

July 1 OhioRISE Launch Announcement and Resources

Ohio’s first-ever highly specialized program to help children and youth who have complex behavioral health and multisystem needs who are served by Medicaid launched July 1, 2022. This huge step forward for ensuring every child has the chance at a bright future is outlined, with overview and resources.

 

Feature Article

Health Equity, SDOH and How They Relate to HEDIS

Health Equity is the cumulative process of addressing macro and micro injustices that impact or impede the ability of any individual to reach their best health outcome. This includes social, economic, health and other policies that impact individual autonomy. Read how Health Equity and Social Determinants of Health (SDOH) are key strategies used by healthcare providers

 

Announcements

Medicare: Peer to Peer & Elective Medical IP Auth Process Changes

To reduce administrative burden on our provider partners, Wellcare By Allwell is making the following changes to both our peer-to-peer review request requirements and elective medical inpatient authorization process.

New Website Page: Provider Relations Representative Territories

We’re excited to share that in our ongoing efforts to make doing business with Buckeye easier, we’ve developed a new Provider Relations Representative Territories website page. It includes all you need to determine who your Provider Relations Representative is and how to reach them.  

New Member Languages and Interpreters Website Page

Buckeye Health Plan members speak more than 49 languages, and the population grows more diverse each year. We’ve made working with us easier by providing you with a page about our member languages and how to work with an interpreter.

Annual Public Form SUD 1115 Demonstration Waiver Meeting August 16, 2022

The public forum will open immediately following the regular agenda of the Stakeholder Advisory Committee. During the public forum, any interested party is invited to offer comments on any aspect of the waiver. See details.

Spotlight Peer Support: Substance Use Disorders- Awareness, Facts, Screening Tools 

In America, the disease of addiction was given the opportunity to hide in the shadows of moral responsibility, in a chasm of debate concerning its pathology. As the debate narrowed and the science exposed the medical nature of addiction and alcoholism; the next frontier of the healthcare system has appeared.

 

FYI

Electronic Visit Verification (EVV)

Providers rendering EVV-eligible services should monitor their remittance advices or our web portal for EVV error information codes on claims. 

LPN Licensure Reminder

LPN license renewal begins July 1, 2022. In May 2022, the Board will begin sending renewal information through eNews and social media, and please check…

ODM Oral Health Program

The Ohio Department of Health (ODH) Oral Health Program created a 30-second educational video for caregivers on infant oral health, as part of a statewide public awareness campaign. The video is called “Building Blocks to Healthy Teeth” and it contains five messages or “building blocks” that address key infant oral health practices.

2021 Community Impact Report

During the COVID public health emergency in 2021, Buckeye Health Plan joined with community agency partners and Ohio’s other Managed Care plans to vaccinate nearly 1 million underserved Ohioans. Together with local pharmacy and retail partners, we created hundreds of local events to bring vaccination into areas of greatest need.

Buckeye’s preventative health programs provided our members with comprehensive information about how to take care of their health and why it is so important to visit their doctor each year – in person or via telehealth.

To learn more about Buckeye's many contributions to the health of our communities, please see our 2021 Community Impact Report.

Welcome to the June 2022 Provider Update Newsletter

June 29, 2022

OhioRISE Updates

In preparation for the launch of OhioRISE on July 1, 2022, we’ve created a specific OhioRISE section on the website dedicated to all things OhioRISE. It’s a comprehensive section, broken into categories to ease navigation to find what you need. Be sure to check there for updates, FAQ’s and for all things OhioRISE.

• Latest Updates in What You Need to Know:
  • June 28: Coverage of Psychiatric or Substance Use Disorder
  • June 21: Update to June 16 notice on 2022 Practitioner modifiers on Aetna OhioRISE Claims
  • Member ID Cards

 

Feature Article

Behavioral Health: Movement and The Impact on Health

The impact of exercise on health and wellbeing has been a topic of interest in public health for many years. According to the John W. Brick Mental Health Foundation’s June 2021 report, “routinely moving our bodies is a key element in the ecosystem of factors that help us to build our mental and emotional well-being” and “motion is indisputably associated with mental health benefits.” See the details.

 

FYI

ODH Important Update on Infant Formula

Due to the recent Abbott infant formula recall and related formula shortages, the ODH WIC Program is temporarily allowing several flexibilities…

 

Training

Rescheduled Date: August 23, 2022, Comprehensive Primary Care (CPC) Webinar is on Big 5 Initiatives 

The date for the Comprehensive Primary Care (CPC) Webinar on Big 5 Initiatives is now August 23, 2022. This webinar will focus on an overview of the Big 5 Initiatives happening at ODM and will provide CPC practices the opportunity to ask questions prior to our scheduled go-live later this year. Click here for details and to register. 

Welcome to the May 2022 Provider Update Newsletter

Next Gen Contract Updates

• For your reference, we have made samples of the 2022 Participating Provider Agreement and Ohio Provider Product available on our website.
• In preparation for the launch of OhioRISE on July 1, 2022, the Ohio Department of Medicaid continues to provide training and guides to support and assist you in getting up-to-speed on the OhioRISE program. We have posted the latest announcements:
  • June 21: Module 4 Training – Local and Statewide Systems Engagement
  • ODM Provider Enrollment and Billing Guide

Announcements

• New Medicare Medication Adherence Tool
• Data shows that out of every 10 of your patients, three are not taking their medications as prescribed. We’re introducing a new program called RxEffect to assist in improving non-adherence for your Medicare Advantage patients.
• 2022 P4P and P4Q Measurement Charts
  We have posted the 2022 P4P Measurement Charts for Medicaid and Ambetter and the P4Q Measurement Chart for Medicare on our incentive page.
• Medicare Prior Authorization Update
  We are committed to delivering cost effective quality care to our members, which requires us to ensure that our members receive only treatment that is medically necessary according to current standards of practice. Please see the Medicare Prior Authorization Changes for changes effective July 1, 2022.
   

Feature Article

May is Mental Health Awareness Month

In celebration of May Mental Health Awareness Month, we want to introduce you to Ohio Systems of Care Project ECHO for Multi-System Youth.
 

FYI

• Behavioral Health Micro Learnings Available
  BH clinical liaisons of the Members Empowered to Succeed Team, along with the Partnerships in Care Team, have identified gaps in provider resources and made available Micro-Learnings and Tip Sheets for your use.
• Preventive Health and Clinical Practice Guidelines have recently been updated. Stay up to date on the latest information. See Medicaid, Medicare Advantage, MyCare Ohio here. See Marketplace here.
• Website improvements: Buckeye is continually looking for ways to make working with us easier.
  • New ‘Updates’ Page
    Recently, a new ‘Updates’ page was added to our Important Notices and Updates on the left menu options on our Home Page. Moving forward, you’ll find all Buckeye updates in one centralized location, in chronological order.
    
    
  • New ‘Our Community Connections’ Page To make it easier to find our many community-based programs, we created one centralized page, listing all Buckeye community programs, along with a brief description and link to full details. Access to our new centralized page is through a top menu tab, located on all website pages, called: Our Community Connections. Don’t worry, we haven’t moved any of our current community-based program website pages, simply provided a centralized access page.

Welcome to the April 2022 Provider Update Newsletter

April 29, 2022

Announcements

• New Next Generation Contract – ODM’s Latest News: visit our dedicated Next Gen website page for the announcement and all the additional information we’ve collected in one place for your ease of access.
• OhioRISE Website Page: we have created our own consolidated OhioRISE website page with the latest information, new video to review and links to training and more.
• Effective April 13, 2022, Buckeye is following ODM guidance to rescind the lift of all prior authorizations and/or pre-certifications for all long-term acute care facility (hospital), skilled nursing facility (SNF), and Inpatient Rehabilitation facility (IRF-hospital) admissions that was previously announced. See the entire announcement.

FYI

Buckeye Health Plan and Ohio University Partnership Programs Video: In 2021, Buckeye Health Plan partnered with Ohio University to support two programs to expand access to healthcare and increase the knowledge base for those administering care in rural areas of Ohio. See our thought-provoking video.

• New - OSMA Well-Being CARE Service Program for Healthcare workers. The Ohio State Medical Association has launched a Well-Being Checkup and Referral Engagement Service for Ohio’s healthcare workers. This simple, free and anonymous checkup of your mental and emotional health is available to any healthcare worker. 
  • Program description:
    • Stress, anxiety, and the pressures of day-to-day life affect us all. Sometimes those pressures can negatively affect our happiness and disposition, our relationships with others, our job satisfaction, and even our feelings and beliefs about ourselves. 
    • The Well-Being CARE Service is available at no cost to Ohio's healthcare workforce. The first step is a voluntary and completely anonymous questionnaire designed to help you assess your current state of mental health and well-being. Once completed, a licensed mental health professional will review your questionnaire and provide you with a personalized response that includes, should you be interested in pursuing them, vetted services that are available throughout Ohio in person and via telehealth.
    • If you are interested in participating in this beneficial program, you will find all details at: www.wellbeingcare.org.

Training Opportunities

• AAP Spring Meeting on May 6: The Future of Pediatrics – Disrupters in Primary Care, How to Compete and Succeed While Protecting the Medical Home. More information and Registration.
• Quality Education Series: a 4-part series for our Medicare product.
• June 9 Comprehensive Primary Care (CPC) Webinar is on Big 5 Initiatives
  Save the date for ODM’s next CPC webinar! It is scheduled for June 9, 2022, from 2:30-3:30 p.m. This webinar will focus on an overview of the Big 5 Initiatives happening at ODM and will provide CPC practices the opportunity to ask questions prior to our scheduled go-live later this year. Register here.  If you have been unable to attend any of our previous webinars, the recorded versions and their presentations are available here.

Welcome to the March 2022 Provider Update Newsletter

March 30, 2022

 

Announcements

• Update Provider Master File before MITS Freeze in May
  In preparation for the rollout of the new Provider Network Management (PNM) module and Centralized Credentialing system, ODM is expected to implement a freeze period sometime in May. See the details.
  
  
• OhioRISE CANS Training
  The Ohio Department of Medicaid (ODM) invites you to attend Module 2 of the OhioRISE community and provider training series to help you prepare for implementing this important program in July 2022.

 

Policy Updates

New: Short Inpatient Hospital Stay
Beginning May 1, 2022, inpatient stays of less than 48 hours may be converted to an observation status unless one of the exceptions listed within Clinical Policy: Short Inpatient Hospital Stay are met. You will find a copy of the policy in the Clinical and Payment Policies section of Provider Resources. The Short Inpatient Hospital Stay policy is applicable to Medicare (Wellcare By Allwell) and Marketplace (Ambetter) lines of business.

 

Reminders

Ohio Department of Medicaid Now Requires Medicaid ID Number
Effective March 1, 2022, Buckeye Health Plan will be enforcing this ODM requirement for claims received on or after March 1, 2022.  Providers will be required to have an active Medicaid ID on file with Buckeye Health Plan for all claims, regardless of the date of service. See the website for more information.

 

Feature Article

Nutrition and Mental Health
Studies have found a correlation between a diet high in refined sugars and impaired brain function – or even a worsening of symptoms of mood disorders, such as depression. See how Buckeye helps our members use ‘premium fuel’.

 

For Your Information

• New Member Health Benefit Tip Card Library: At Buckeye Health Plan, the health and well-being of our members are our top priority day in and day out. This library contains benefit tip cards that can be used as an education resource on topics like asthma, diabetes, heart health and more. There’s even information about “where to go for care” based on your current medical need. We hope you’ll find these useful for your patients.
  
  
• We’ve updated our Wellcare By Allwell website page with contract numbers and coverage maps.
  
  
• The Centene Foundation for Quality Healthcare has awarded a grant to one of Centene’s strategic partners, Healthcare Ready (HcR), for a two-year project aimed at increasing all hazards planning and preparation for community health centers to improve resilience and rapid recovery in response to disasters. See details: links for upcoming live webinar trainings, on-demand recordings other resources available.
  
  
• Buckeye’s Preventive Health and Clinical Practice Guidelines have recently been updated. For the most up-to-date version of these guidelines: Medicaid, Medicare Advantage, MyCare Ohio and for Ambetter

 

DYK

Checking the Status of a Claim: did you know you can check the status of a claim 24 hours a day?

 

Training Opportunities

Weitzman ECHO Series for Ohio: Women's Health in Primary Care 
Kick-off for our ECHO series collaboration of the Weitzman Institute, Buckeye Health Plan and Ohio University was March 10, but there is still plenty of time to register for the remaining sessions through November. 

Welcome to the February 2022 Provider Update Newsletter 

February 24, 2022

Announcements

• New Medicare and Ambetter Update: Extending PA waiver for SNF, LTACH and Inpatient Rehab admission reviews continue through February 28, 2022.
• Medicaid PDL Updates: New Non-Preferred Drugs effective April 1, 2022
• Correction coming for Episodes of Care Results:  Recently, you may have received a letter from Buckeye re: the 2019 Episodes of Care Results and outstanding 2018 negative incentive amounts.

Reminder

Ohio Department of Medicaid Now Requires Medicaid ID Number

Effective March 1, 2022, Buckeye Health Plan will be enforcing this ODM requirement for claims received on or after March 1, 2022.  Providers will be required to have an active Medicaid ID on file with Buckeye Health Plan for all claims, regardless of the date of service. See the website for more information.

Feature Article:  No One Eats Alone^® Day:

Having a seat at the table is vital to ending social isolation in youth and creating a culture of belonging. That’s why Buckeye Health Plan is so excited that students in 13 Ohio schools are participating in National No One Eats Alone^® Day on February 24 and 25, as well as dates into March 2022.
 

Quality

• CAHPS’ Importance to You
  The 2022 CAHPS Survey began delivering in February and will continue through May. This is the opportunity afforded to our members to rate the care they receive from their providers and Buckeye Health Plan. We’ve outlined how CAHPS is important to you. Be sure you check out why it’s important to you and our Tip Sheet.
  
  
• HEDIS TIME: February to June 2022

Employers and individuals use HEDIS to measure the quality of health plans. It measures how well health plans give service and care to their members. The data from these measures are reported to the National Committee for Quality Assurance (NCQA), which rates health plans based on more than 90 measures across six areas of care.

Training Opportunities

• In collaboration with Buckeye Health Plan and Ohio University, Weitzman Institute is excited to announce that registration is now open for the Weitzman ECHO Women Health, on March 10.
• AAP Spring Meeting on May 6: The Future of Pediatrics – Disrupters in Primary Care, How to Compete and Succeed While Protecting the Medical Home. More information and Registration.

Welcome to the January 2022 Provider Update Newsletter 

January 31, 2022

 

Provider Partners:

Happy New Year from the entire Buckeye Health Plan Network team!  We look forward to enhancing our trusted partnership in 2022. As we move into the Ohio Department of Medicaid’s new vision for managed care, we recognize exciting opportunities to strengthen our relationship and positively impact your ability to serve our members. Together, we will focus on improving care coordination and meeting individual member, your patient’s, needs to achieve greater outcomes across our Medicaid, Medicare and Marketplace products.

I look forward to partnering with all of you during an inspiring year of growth in 2022.

Respectfully,

Natalie Lukaszewicz
VP, Network Development and Contracting

Announcements

• ODM Medicaid Number required for payment starting March 1, 2022
  Effective March 1, 2022, Buckeye Health Plan will be enforcing this ODM requirement for claims received on or after March 1, 2022.  See the website for more information.
• New Behavioral Health Program – BuckeyeSpectrum
  Buckeye will soon launch a new program designed to enhance treatment of Schizophrenia Spectrum Disorders for its members. It’s a first of its kind collaborative program. See the details.
• Wellcare by Allwell Medicare Advantage PPO
  We are proud to offer a comprehensive selection of Medicare Advantage plans in your area, including our new Preferred Provider Organization plan (PPO) for 2022. See more details on our PPO.
• Reducing Administrative Burden for Hydration codes
  In our ongoing quest to reduce administrative burdens by listening and following through, we are excited to share new changes for our Hydration codes.
• New Medicare & Ambetter Update:
  Extending PA waiver for SNF, LTACH and Inpatient Rehab admission reviews continue through February 14, 2022 for our Medicare products.

For Your Information

• Behavioral Health Readmission Recoupment – New Policy
  The Managed Care Entity (MCE) members of the Ohio Association of Health Plans (OAHP) have received approval from the Ohio Department of Medicaid, to implement a single MCE standard 30-Day Behavioral Health Readmission Policy and associated claims and clinical review programing.
• COVID Updates
  The Vax on the Spot COVID Vaccine program has been extended through June 30, 2022. We have all the details and a new FAQ.
• Compassionate Connects Program in Northeast Ohio 
  Compassionate Connections provides support to members with chronic illnesses that may need assistance with managing their health within their home and assists with filling care gaps. See the details of our unique program.

Training Opportunities

Health Care Professional Virtual Roundtable Series
Improving Outcomes for People with Disabilities

February – November 2022
One-hour, monthly, interactive roundtables aim to improve the experiences and outcomes of people with disabilities. See our website for more information.

Reminders

• Submit PAs via portal.
  Just a reminder the preferred method of submitting a Prior Authorization is through our portal. When the new ODM contract begins July 1, 2022, it will be a required method to submit your PAs. We have shared the step-by-step directions to submitting PAs through our Buckeye portal on the Prior Authorization section of our website. 
• Specialty Medication Prior Authorization Form
  Effective 1/1/22, we have streamlined our procedure to find a Prior Authorization Form for a specialty medication. Rather than the previous Search Function, we now have one General Specialty Medication PA Form for use across all specialty medications. Please note, there is also a new fax# to submit the form.
• New Pharmacy Benefit Manager beginning January 2022
  Effective January 1st, 2022 Buckeye Health Plan will transition their Pharmacy Benefit Manager (PBM) from Envolve Pharmacy Solutions to…..

Welcome to the December 2021 Newsletter 

In observance of the holidays, Buckeye Health Plan will be closed on Monday, January 3 and Monday, January 17, 2022.

Dear Provider Partners --

On behalf of Buckeye Health Plan, I am sending you our best wishes for a wonderful holiday season and healthy New Year. We deeply appreciate your partnership, and commitment to supporting our members’ healthcare needs throughout the many challenges and changes brought on by the COVID pandemic this year. Together, we have led with heart to bring compassion, connection, authenticity and accountability to all that we do.

In the New Year, we look forward to partnering with you to help fulfill Ohio Medicaid’s bold new vision for managed care that is focused on providing a more seamless and individualized experience for members and providers.

Together, we are transforming the health of the community, one person at a time.

Happy Holidays!

Respectfully,

Steve Province, FACHE
President and CEO

 

Announcements

• Medicare Update: Extending PA waiver for SNF, LTACH and Inpatient Rehab admission reviews continue through January 31, 2022 for our Medicare products.
• New Medicare Billing Effective January 1, 2022: The Centers for Medicare and Medicaid (CMS) have released several billing changes and updates for various Medicare services that take effect on January 1, 2022. As a valued Wellcare By Allwell provider partner, we want to make you aware of how these changes will impact your billing activities with us in 2022.

 

Pharmacy

Specialty Medication Prior Authorization Form. Effective 1/1/22, we have streamlined our procedure to find a Prior Authorization Form for a specialty medication. Rather than the previous Search Function, we now have one General Specialty Medication PA Form for use across all specialty medications. Please note, there is also a new fax# to submit the form.

 

Feature Article

Behavioral Health - Coping with Stress and Anxiety during the Holidays

Holidays give us all the expectation of warmth, peace, and celebration with family and friends.  We think of gathering and sharing our love and happiness. However, the reality is that the time leading up to the holidays is often spent trying to create the ideal holiday for those around us, and that can cause…
 

For Your Information

• Check Run Schedule for January
  • Checks issued Wednesday, January 5, 2022, and Friday, January 7, 2022, for the week after New Year’s.
  • Checks issued Wednesday, January 19, 2022, and Friday, January 21, 2022, for the week of January 17.
     
• Diabetes Campaign: To allow all MCO providers to find information regarding our Diabetes W/H Campaign in one location, OAHP has generously offered their website as a collection point. If you need the latest information around the campaign, you can go to OAHP.
  
  
• Did You Know
  If you receive a claim denial with one of these denial codes, you can request a claims reconsideration.

 

Training Opportunities

Ohio Children’s Initiative Child and Adolescent Needs and Strengths (CANS) training dates

The January Ohio Children’s Initiative Child and Adolescent Needs and Strengths (CANS) training dates are now available. Additional resources are included such as an updated CANS FAQ, to help simplify registration and enrollment, the CANS interim billing guidance, and helpful contacts. See the OhioRISE website for more information.

 

Reminders

• New Pharmacy Benefit Manager beginning January 2022
  Effective January 1st, 2022 Buckeye Health Plan will transition their Pharmacy Benefit Manager (PBM) from Envolve Pharmacy Solutions to…..
  
  
• EVV Payment Reduction - Our apologies, please disregard the reminder below. ODM has not yet made the change. You can get more information at ODM. 
  
  Previously, ODM shared plans to begin a 10% reduction in payments that cannot be matched to visits in the EVV system.  Originally scheduled for the summer of 2021, it was extended through December 31, 2021.  These payment reductions are effective January 1, 2022.

Welcome to the November 2021 Provider Update Newsletter

In observance of the holidays, Buckeye Health Plan will be closed on Monday, December 27, 2021 and Monday, January 3, 2022. 

Announcements

1.    New Pharmacy Benefit Manager beginning January 2022

Effective January 1, 2022 Buckeye Health Plan will transition their Pharmacy Benefit Manager (PBM) from Envolve Pharmacy Solutions to…..

2.    COVID Vaccine Campaign: Gift Card Program for Children and Youth in Custody

Medicaid MCOs are offering a $100 gift card to all Medicaid Managed Care and MyCare members ages 5 years and older who receive their first dose of the COVID-19 vaccination between now and December 31, 2021. For more information, please click here.

3.    Home- and Community-Based Services Provider Rate Increases

In accordance with the budget bill adopted by the 134th General Assembly, the Ohio Department of Medicaid is implementing rate increases for many of Ohio’s fee-for-service home- and community-based services (HCBS) waiver programs. See the details.

Policy Updates

Review new policy updates effective January 1, 2022, for Marketplace: CC.PP.071 and Medicaid and Marketplace: CP.MP.209.
 

For Your Information

1.    The results of the Mock CAHPS (Consumer Assessment of Healthcare Providers            and Systems) surveys are in.

For providers with 5 or more members who responded to the survey, Buckeye Provider Relations and Quality team will be reaching out to discuss your results in the coming months. We will be reviewing:  your overall score, 5 Domain (Getting Needed Care, Getting Appointments and Care Quickly, How well your doctor communicates, Annual Flu Vaccine, Rating of Healthcare Quality, and Care Coordination) scores and offering education on improving your future CAHPS score.

2.    Check Run Schedule for November, December, January Holidays

• Checks issued Wednesday, November 24, 2021, for the week of Thanksgiving.
• Checks issued Tuesday, December 21, 2021, for the week of Christmas.
• New Year's Holiday
      o   Checks issued Tuesday, December 28, 2021, for the week before New Year’s.
      o   Checks issued Wednesday, January 5, 2022, and Friday, January 7, 2022, for the             week after New Year’s.
• Checks issued Wednesday, January 19, 2022, and Friday, January 21, 2022, for the week of January 17.

3.    Did You Know?

How to Remove/Replace Web Portal Login Screen saved as a Favorite/bookmark for various browsers. See the step-by-step guidance.  

Training Opportunities

1.      Ohio Children’s Initiative Child and Adolescent Needs and Strengths (CANS)
         training dates.

The December Ohio Children’s Initiative Child and Adolescent Needs and Strengths (CANS) training dates are now available. Additional resources are included such as an updated CANS FAQ, to help simplify registration and enrollment, the CANS interim billing guidance, and helpful contacts. See the OhioRISE website for more information.

2.    Caring for the Healers Part II: Preventing Suicide Among Providers and Staff

Date: December 16: 1-2 p.m. ET

Learning objectives:

1. Detail the scope of provider and staff suicide, what factors contribute to this phenomenon, and the impact of COVID-19
2. Share practical organizational approaches to address suicide risk and help prevent suicide in providers and team members during and after the COVID-19 pandemic, including management training and response plans.
3. Understand postvention strategies, how to support survivors, and provide opportunities for individual and group assistance. See more details and registration.

Welcome to the October 2021 Provider Update Newsletter

In observance of the Thanksgiving holiday, Buckeye Health Plan will be closed on Thursday and Friday, November 25 and 26 and we’ll back to take your calls on Monday, November 29, 2021.

Announcements

• COVID-19 Announcements

1. Medicare Update to August 27, 2021 PA Waiver
   Buckeye Health Plan will continue our Waiver for Medicare products through admissions on December 31, 2021.  The Waiver will end for the Medicare lines of business effective January 1, 2022. See the details
2. Beginning Monday, Nov. 1, 2021, as part of the provider enhanced reimbursement program for vaccinations, Ohio Managed Care Plans (MCPs) have extended the $100 vaccination administration fee to all doses of…
3. ODM is increasing the rates for at-home vaccine administration for COVID-19 vaccinations. See the details.

• EVV Payment Reduction Delayed
  Previously, ODM shared plans to begin a 10% reduction in payments in the summer of 2021 for claims that cannot be matched to visits in the EVV system.  These payment reductions are delayed until January 2022 or later.
  
  ODM will use this time to help providers become successful with EVV. For example, ODM is starting a small stakeholder group that focuses on support for providers, in addition to current aids, including: webinars, communications with providers about their EVV performance, and individual sessions for providers who need help using the Sandata EVV system.

 

Policy Updates

We continually review and update our payment and utilization policies to ensure that they are designed to comply with industry standards while delivering the best patient experience to our members. We are writing today to inform you of new payment policies Buckeye will be implementing effective 12/01/21.

 

Pharmacy

Change in Pharmacy Prior Authorization Requirements

Effective December 1, 2021, Buckeye Health Plan and Ambetter are making changes to services requiring prior authorization for Medicaid and Marketplace (Ambetter) members. See the details.

 

For Your Information

Flu Prevention: You can help stop the flu!
Strongly recommend to all of your patients to get their annual flu shot.

You have a key role to play in recommending that your patients get the flu shot.  Buckeye Health Plan is here to help. See our Fluvention Campaign page here.

 

Feature Article

October is National Depression and Mental Health Screening Month.

See information on symptoms, treatments and access to resources.

 

Reminders

1. Utilization Management Vendor Updates: Ohio Wellcare UM vendor updates will be effective on November 1, 2021. Read the details. 
2. Claims Escalation Research & Resolution Process
   Buckeye’s Provider Services delivers excellent customer service. They are your first stop for a quest for information. We’ve established a new process for when they are unable to answer or resolve your claims questions. See details.

 

Training Opportunities

As Centene continues our collaboration with the Association of Clinicians for the Underserved (ACU), we have another opportunity for you to participate in a virtual suicide prevention training at no cost. This one is focused on the geriatric population on Tuesday, November 9, 2021 at noon. 

Welcome to the September 2021 Provider Update Newsletter

 

Feature Articles

1.       New! Claims Escalation Research & Resolution Process Complete.

Buckeye’s Provider Services delivers excellent customer service. They are your first stop for a quest for information. We’ve established a new process for when they are unable to answer or resolve your claims questions. See details.

2.      September is Suicide Awareness Month – Understanding Senior Suicide

Over the last two decades, suicide rates have risen 33 percent, leading to a public health crisis. Suicide is the tenth highest leading cause of death in the United States, with nearly 48,000 people dying annually. Mental Health Awareness for Seniors.

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Policy Update

New ‘Hospital Acquired Conditions’ Policy Effective January 1, 2022
(Medicaid, Medicare and Marketplace)

Beginning January 1, 2022, Buckeye Community Health Plan’s adjudication of claims that include Hospital Acquired Conditions will follow current industry practice and… 

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For Your Information

1.     Welcome to Wellcare By Allwell!

As a valued Allwell provider, we want to share some exciting changes to our Medicare plans. See our Provider Notice.

2.     New Member Survey on Buckeye Community Connect

To better support the needs of our members, we’ve added a Social Needs Survey that walks you through a list of possible needs and, once submitted, delivers a customized list of resources based on the survey entries.

3.    Updates to our Find a Provider Tool and Step-by-Step Guide

We have recently updated our Find a Provider (FAP) Step-by-Step Guide to align with our latest updates within the tool, including finding a Specialist.

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Announcements

1.     Medicaid: Early start to RSV Season

Since we are seeing an early increase in RSV infections in 2021, ODM made the decision to start RSV season in Ohio earlier than normal. In our ongoing effort to make working with Buckeye easier, we’ve created a dedicated RSV Season page on our website with everything you need.

2.     Mobile Van Provider Partnerships Available

Buckeye Health Plan is looking to partner with participating providers to facilitate care gap closure events. Our recently introduced Buckeye HealthConnect van serves the state of Ohio and rotates from region to region. Buckeye is looking for provider partnerships. See details.

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Reminders

October is Breast Cancer Awareness Month

According to the National Breast Cancer Foundation, “One and Eight Women in the United States will develop breast cancer in her lifetime.” See HEDIS measure and coding 

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Training & Learning Opportunities

OHIO AAP Virtual Annual Meeting

Keynote Event:

STORE IT SAFE SUICUIDE PREVENTION: STORIES FROM A YEAR LOST
Tools and Resources to De-Escalate a Crisis

OCTOBER 29, 2021

11:30 AM - 1:00 PM - ZOOM Call

We know you have been swimming upstream with the pandemic along with child and adolescent mental health for the past 18 months. Ohio AAP has assembled a multi-disciplinary panel of medical and lived experience experts, including teens, to discuss de-escalation techniques and being prepared to help children and families during a challenging mental health crisis. You will leave with proven, quick and easy tools and techniques to use with children and adolescents in a crisis.

Visit OhioAAP.org for more information or to register FREE TODAY!

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Community Activities

Community Food Initiatives and Rural Action Partnership

Buckeye Health Plan recently partnered with Community Food Initiatives (CFI) and Rural Action (RA), rural food cooperatives that are part of the Appalachian Accessible Food Network in Athens, Ohio, to distribute a total of approximately 10,000 pounds of fresh, local food at two events in August and September. The distribution not only impacted the lives of those who received the food, but also the farmers who grew the food in the region.

Athens County has the lowest median income in Ohio and is the only county in the state with a poverty rate above 30%. Currently, 4.6% of the county's labor force is out of a job, a higher unemployment rate than the state and national averages.^[1] Buckeye is committed to bringing healthy food to low-income communities across Ohio. Underserved residents are likely to suffer from food-related health problems at rates significantly higher than the population as a whole.

The food distribution events in Athens were a great success, with each event distributing about 5,000 pounds of healthy local food to community-based organizations serving 400 Ohio families in need. The distributed items also included health tip cards to further support wellness for underserved Ohioans.

“We’re honored to invest in the lives of our members and all Ohio residents in need,” said Steve Province, Buckeye President and CEO. “And we’re grateful we can partner with all the participating organizations at this event and further the important work they do in the community. Events like these are a part of Buckeye’s commitment to transforming the health of the community, one person at a time.”

Welcome to the August 2021 Provider Update Newsletter

 

In observance of Labor Day, Buckeye Health Plan will be closed on Monday, September 6 and we’ll back to take your calls on Tuesday, September 7, 2021.

Announcements

• We are honored to announce that the Ohio Department of Medicaid (ODM) has awarded Buckeye Health Plan a statewide Medicaid managed care contract that will begin in early 2022.  Our current contract remains in place throughout the transition. Read more details.
• Buckeye Lifting Prior Authorizations and/or Precertifications on All Plans Effective August 27, 2021. See the details.
• Ohio’s Vax on the Spot campaign has added a ages 12+ and extended the deadline. Read all the details.
• Utilization Management Vendor Updates: Ohio Wellcare UM vendor updates will be effective on November 1, 2021. Read the details. 
• Calling All PCP Offices
  We’re working on a special message for staff in our PCP offices. Would any PCP office recipient of this newsletter please answer this brief survey of: provider name, NPI, email address and county. Thanks so much for a few minutes of your time!
• New Medicaid and MyCare Hospice Guidelines

Policy Updates

• OH Enhanced (NCDs) Guidelines Claims Xten Provider Notification: Buckeye Community Health Plan is committed to continuously improving its claims review and payment processes. Effective October 1, 2021, for Medicare, we will enhance several correct coding edits based on industry standards and coding rules. 
• OH Correct Coding Guidelines Flexible Prov Matching Provider Notification: Buckeye Community Health Plan is committed to continuously improving its claims review and payment processes. Effective October 1, 2021 for Medicaid, Marketplace and Medicare lines of business, we will enhance several correct coding edits based on industry standards and coding rules. 

Feature Articles

• As we continue our Behavioral Health Education Series, this month’s feature provides helpful information on Mental Health Advocacy Groups. 
• Ohio MCPs partner with ODM to provide Diabetes Self-Management Education (DSME) benefits to Medicaid members. Read the benefits and coverage of DSME. 

For Your Information

• Buckeye began a robust Dental campaign to our members in August and created a fun Infographic for your use as talking points or to share with your patients. See the details. 
• Quick reference link to ODM’s new website for the Fee Schedule and Rates page. 
• Did You Know: How to see if code needs prior authorizaton on website.
• Medicaid Only – Changes to coverage of Continuous Glucose Monitors (CGMs) and Quantity Limits for Diabetic Supplies 
• New helpful FAQs added to the Appeals page of the website.

Training & Learning Opportunities

• Training on New Nursing Facility Request Form
• Sandata EVV training September webinars. Learn the details. 
• OHIO AAP FOUNDATION FUNDRAISER LUNCHEON
  STORIES FROM A YEAR LOST:
  School-Age Children and How Ohio AAP Can Help
  
  Emily Harris, MD, MPH, FAAP, Director, Pediatric Psychiatry Integration, General Pediatrician, Child and Adolescent Psychiatrist, Cincinnati Children’s Hospital Medical CenterJoin the exciting launch of our newly designed Building Mental Resilience resources and materials at the conference luncheon, receive exclusive access to materials to use with your patients, clients, students and families.
  
  OCTOBER 29, 2021
  
  11:30 AM - 1:00 PM
  POLARIS HILTON-COLUMBUS
  
  Individual ticket price: $40/member or $60/non-member
  Register here to join us in-person or via Facebook live: OhioAAP.org/21BMR

Welcome to the July 2021 Provider Update Newsletter

In observance of Labor Day, Buckeye Health Plan will be closed on Monday, September 6 and we’ll back to take your calls on Tuesday, September 7, 2021.

COVID/Vaccine Updates

Exciting updates to our Vax on the Spot joint initiative with the Ohio Department of Medicaid and all 5 Ohio Managed Care Plans:

• Added a Provider tab to the Vax on the Spot microsite to make it easy for providers to find everything they need in one place. Visit Vax on the Spot.com.
• The end date of the initiative is extended from August 15 to September 15.
• Increasing our member incentive to $100.

Look for an updated communication and flyer in the next few days.

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Our Buckeye HealthConnect Van is Hitting the Road!

We are excited to launch our new Buckeye HealthConnect Van! We'll be bringing healthcare services and resources to communities across the state. Read more about the services offered and where your patients will find it.
 

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Emergency Broadband Benefit Helps Increase Telehealth Usage

Helping patients stay connected digitally through broadband services has proven to be more than a luxury: it is a necessity. The FCC has created a new program for patients in underserved areas. See if your patients qualify.

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Behavioral Health Feature: Psychotic changes and Schizophrenic Disorders

Read about what these disorders include, the symptoms associated with them and how they are treated.

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New PTSD Video

Buckeye talks with the Zepf Center about PTSD: the symptoms, treatment and how COVID-19 may be impacted.
 

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Provider Communication Sign-up Form

Whether you are an office manager, clinical staff, physician, billing or front desk worker, or serve in another role within our provider locations, Buckeye would like to share relevant, timely information that makes it easier to do business with us. Please sign up for Provider Communications. Even if you have received our email communications in the past, please complete the form for future targeted communications.

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Ambetter Prior Authorization Change Notifications

• Adding Medical Implanted Devices and Stereotactic Radiosurgery to prior authorization list effective November 1, 2021.
• Adding Home Health services to prior authorization requirements.

See the details.

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New Electronic PRAF 2.0

See the many benefits the new electronic PRAF 2.0 brings in one simple submission.

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Sandata Mobile Connect App Update

You must update your SMC app by August 1, 2021, or it will no longer work.

Sandata releases updates to the SMC app on a regular basis. You must install these updates  to ensure the SMC app continues to work.

How can I make sure my app is updated?

1. Turn on auto-updates for the SMC app.
2. Manually check the app store for your smart device and install the update.
   • Go to your smart device’s app store to check for and install the latest update for the SMC app. The app store should show the version number and date of the latest update that is available.

Once you have installed the latest update, you should see an app version of 1.1.629 or higher on the login screen.

Note: To install the latest SMC app updates, Apple devices must be running the Apple operating system (iOS) 12 or higher and Android devices must be running the Android operating system of 4.4 or higher.

What if I don’t update my app by August 1, 2021?

If you are not using version 1.1.573 or higher of the SMC app by August 1, 2021, your app will no longer be supported and will not work.

To fix this, you must:

1. Delete the SMC app from your phone
2. Go to your smart device’s app store
3. Re-install the SMC app

This will ensure that you are using the latest version and that it will work as expected. 

It is important to make sure that you install SMC app updates. Sandata emails a release notification to providers when there is a release, or updates, coming out for the app. The email includes the date that the update will be sent out, and what the new version of the app will be. The updates that are mentioned in the email will be available to install from the app stores on either Apple or Android devices about a week or two after the release notification email is sent.

If you have questions about installing app updates on your smart device, please reach out to the maker of your smart device. If you have questions about the SMC app itself, please reach out to EVV Provider Hotline at 855.805.3505.

Welcome to the June 2021 Buckeye Provider Update Newsletter

In observance of Independence Day, Buckeye Health Plan will be closed on Monday, July 5. We’ll be back to take your calls on Tuesday, July 6.

Buckeye Community Activities

• Buckeye is transforming the health of the community one person at a time.
  See our 2020 Community Impact Report.
• Access to healthy, affordable produce can be a challenge for many Ohioans. Buckeye is partnering with Produce Perks, a healthy food incentive program, and local farmers across the State to host Buckeye Fresh! farmers’ market days.
• Buckeye is pleased to team up with all Ohio Managed Care Plans and ODM to encourage all Ohio Medicaid and MyCare members to get the COVID-19 vaccination by August 15.  All Ohio Medicaid and MyCare members age 18 and older who receive their first dose of the COVID-19 vaccine between June 15, 2021 and August 15, 2021 will receive a $50 incentive! Visit COVIDVaxOnTheSpot.com for details about vaccine events near you! 

COVID/Vaccine Updates

See our new Medicaid COVID Vaccine page with the latest information.

• Increase in Administrative Fee for COVID-19 Vaccines
• Our temporary Medicare Plan Waivers are expiring for applicable COVID-19 treatment and telehealth services on June 1, 2021.

Behavioral Health Feature: PTSD

June is Post Traumatic Stress Disorder (PTSD) awareness month. Read about PTSD’s definition, symptoms and treatment. Also view Vivian’s Story, a Mission Moment video about our member’s journey from depression to wellness.

Pharmacy: Continuous Glucose Monitoring Systems Coverage

Did you know…..Buckeye has a clinical policy in place for Medicaid members who meet the criteria for a Continuous Glucose Monitor? See our new policy.

Behavioral Health Learning Opportunities

Best practices for late adolescents who do not have adequate treatment planning and case coordination to successfully transition to adulthood.

Temporary Medicare Plan Waivers Expiring

Please note: Our temporary Medicare Plan Waivers are expiring for applicable COVID-19 treatment and telehealth services on June 1, 2021.

Implementing Hospital 30-Day Readmission Policy

(Medicare and Ambetter only, excludes Behavioral Health)

As you know, we continually review and update our payment and utilization policies to ensure that they are designed to comply with industry standards while delivering the best patient experience to our members. We are notifying you of a new policy Buckeye Health Plan will be implementing effective August 15, 2021.

Policy Number: CC.PP.501

Policy Name: 30-Day Readmission

Line of Business: Medicare, Marketplace

Policy Description:  All hospital claims submitted for a plan member that qualify as a readmission within 30 days of a discharge from the same hospital or a related hospital are subject to clinical review.

If there are questions about this or any of our payment policies, please don’t hesitate to reach out to our Provider Services team at 866.296.8731.

P4P / CoC Performance Programs

We are happy to deliver our 2021 Quality Incentive Program to our primary care physicians. This year there are separate programs: one each for Medicaid, Medicare and Ambetter, as well as some change in criteria.  Check out the programs.

Interoperability: Digitally Connecting Patients, Providers and Payers

In 2020, CMS finalized their Interoperability and Patient Access Rule (CMS-9115-F). Interoperability seeks to remove data barriers and silos within the healthcare industry, connecting people with the information and tools they need to make informed decisions about their health. Read more on this important information.

We need your help!

Buckeye wants to make working with us as easy as possible.  We are creating a Provider Pharmacy Guide for your use as a quick reference guide to your most commonly asked questions, processes, the PDL and various other Pharmacy topics. To ensure we address all your needs, will you please complete the quick (5 questions) survey to share your thoughts. We appreciate your assistance.

Provider Communication Sign-up Form

Whether you are an office manager, clinical staff, physician, billing or front desk worker, or serve in another role within our provider locations, Buckeye would like to share relevant, timely information that makes it easier to do business with us. Please sign up for Provider Communications. Even if you have received our email communications in the past, please complete the form for future targeted communications.

 

 

Welcome to the May 2021 Buckeye Provider Update Newsletter

 

COVID Vaccine Updates

See our Medicaid COVID Vaccine page with the latest information.

• Vax-a-Million Details and Talking Points
• 5-11-21 Weekly Update from ODM
  • FDA/CDC Updates
  • Webinar-Best Practices for vaccinating children
  • Bringing the vaccine to neighborhoods
  • New resources

 

Provider Communication Sign-up Form

Whether you are an office manager, clinical staff, physician, billing or front desk worker, or serve in another role within our provider locations, Buckeye would like to share relevant, timely information that makes it easier to do business with us. Please sign up for Provider Communications. Even if you have received our email communications in the past, please sign up for future communications. You can view our Provider Update Newsletter Archive at the link at the bottom of the page.

 

Mental Health Awareness Month

Since the onset of COVID-19, the CDC reports that one in four adults reported experiencing symptoms of an anxiety or depressive order in February 2021 - a significant increase from previous years. Read about the many programs Buckeye offers and hear Vivian's story of returning to wellness after depression.  

 

Behavioral Health Prior Authorization Changes

 [All Medicaid and Medicare Providers]

In our efforts to streamline the prior authorization process and remove some administrative burden, we are implementing the following changes related to behavioral health services…

 

New Somatus Care Management Program for Patients with CKD/ESRD

[All Allwell Advantage HMO Providers]

Effective June 1, 2021, Buckeye will partner with Somatus Inc., to establish a care management program for members with end-stage renal disease and chronic kidney disease. Some of your patients may qualify for this program.

Patient benefits include:

• Care management of kidney disease and comorbidities
• Instruction to better understand the condition, treatment options and diet
• Help to transition from hospital to home
• Guidance in transplant options
• Social workers can help with transportation, food or other issues that limit the member’s compliance with treatment. 

We will be in touch with you about your eligible patients. If you have questions before we contact you, please call Somatus at 855.851.8354, Monday-Friday from 9:00 a.m. to 5 p.m. eastern time.

 

Point of Care Formulary Information for Providers

[Medicare]

Are you and your team spending valuable time processing prior authorizations?

In our ongoing efforts to make working with us as easy as possible, we have expanded our relationship with Managed Markets Insight & Technology, LLC (MMIT) to deliver comprehensive drug coverage information directly to your desktop and mobile devices. In addition to Allwell from Buckeye Health Plan’s extensive support resources, providers can identify plan-specific drug coverage and restriction criteria as well as alternative therapies with these medical applications.

• Epocrates^®, an athenahealth service, is the #1 point of care medical app among U.S. physicians. It is trusted by over 1 million healthcare professionals. Just download the free app or search from your desktop with epocrates^® web at epocrates.com.
• MMIT’s Coverage Search is a top-rated drug coverage search application. Download the free app or search from your desktop at FormularyLookup.com.

Quickly obtain the details you need to select the best therapeutic option, eliminate denials and reduce administrative drain on you and your team with epocrates^® and Coverage Search.

Need help getting transportation services for our members?

To make it easier for you to assist members with transportation services, there is now a centralized Managed Care Plan phone number for providers to call if they need to help coordinating transportation services. Find the phone number and more details on our website.

 

Reminder: Allwell and MyCare Ohio Model of Care Training

All Allwell and MyCare providers are required to complete an annual Model of Care training.

Welcome to the April 2021 Buckeye Provider Update Newsletter

COVID Vaccine Updates

See our Medicaid COVID Vaccine page with the latest information.

• Johnson & Johnson (Janssen) Vaccine
• Medicare COVID Billing Guideline Updates
• 4-23-21 Weekly Update from ODM
• New COVID Nursing Facility Tool Kit
• Medicare Member Liability Reinstatement effective June 1, 2021

Provider Communication Sign-up Form

Whether you are an office manager, clinical staff, physician, billing or front desk worker, or serve in another role within our provider locations, Buckeye would like to share relevant, timely information that makes it easier to do business with us. Please sign up for Provider Communications. Even if you have received our email communications in the past, please sign up for future communications. You can view our Provider Update Newsletter Archive at the link at the bottom of the page.
 

MyCare Home Health RN Assessment Extension

In our ongoing efforts to make working with Buckeye as easy as possible, we are modifying our Home Health RN assessment billing policy.
 

EVV Training

Ohio Department of Medicaid (ODM) continues to offer providers the opportunity for more personalized Electronic Visit Verification (EVV) system training and an EVV account review.
 

How to file an NIA/Magellan Health appeal
You asked, we listened. We’ve provided you step-by-step instructions on how to file an appeal with NIA/Magellan Health.
 

We need your help!

Buckeye wants to make working with us as easy as possible.  We are creating a Provider Pharmacy Guide for your use as a quick reference guide to your most commonly asked questions, processes, the PDL and various other Pharmacy topics. To ensure we address all your needs, will you please complete the quick (5 questions) survey to share your thoughts. We appreciate your assistance.
 

Autism Awareness Month

Autism is a pervasive developmental disorder that affects children in all areas of the world, and presents significant challenges to children and their families. Understanding that autism affects children around the world the United Nations General Assembly passed a resolution on December 18, 2007, to establish a World Autism Day. Learn more details.

Welcome to the March 2021 Provider Update Newsletter

 

COVID/Vaccine Updates

See our new Medicaid COVID Vaccine page with the latest information.

• The latest ODH Weekly Update -  includes new J&J vaccine information
• ODM has changed the reimbursement rate for the administration of  the vaccine
• Post- Acute Care Prior Authorization Changes
• Updated Medicaid Billing Guidelines
  
  

Provider Communication Sign-up Form

Whether you are an office manager, clinical staff, physician, billing or front desk worker, or serve in another role within our provider locations, Buckeye would like to share relevant, timely information that makes it easier to do business with us. We are building our email address list for future email communications. If you haven’t yet, please complete our Sign-Up Form, even if you have received our email communications in the past.

 

Website Updates

To continue to make working with Buckeye easy, we’ve made some website enhancements.

1. Submitting additions or changes to contracted providers and facilities. We’ve updated the New Provider Enrollment Form, New Location Form and Facility Form. In addition, we’ve streamlined the flow and content for provider updates and changes. See details.
2. Updated content on the Appeals page.
3. New Claims Appeal Process on our portal. You’ll find step-by-step instructions on the Appeals page.
   
   

Helping Your Patients Understand Telehealth

Using telehealth for office visits can be confusing and difficult for some members. To better understand this newer technology, we’ve provided helpful instructions and videos to share with your patients, as well as a Tip Sheet they can download, in the member section of our website.

Behavioral Health Feature: Bullying

As schools begin to reopen and more social interaction resumes, it’s important to remind yourselves of the importance of recognizing and addressing bullying. Please read our article and view our brief video.

 

New Prior Authorization Tool

InterQual Connect™ Effective April 15, 2021

Buckeye values our provider relationships and want to ensure doing business with us is easy and straightforward. We are pleased to announce, effective April 15, 2021, the integration of an exciting new tool, InterQual Connect™ in our Secure Provider Portal. Read about the new features coming soon.

 

CAHPS’ Importance to You

The 2021 CAHPS Survey began delivering in February and will continue through May. This is the opportunity afforded to our members to rate the care they receive from their providers and Buckeye Health Plan. We’ve outlined how CAHPS is important to you. Be sure you check out why it’s important to you and our Tip Sheet.

 

EVV Updates

• Reminder: EVV Overview and Updates for Case Managers I Friday, March 26: 10:30am – 12:00pm I Register
• EVV Payment Reduction Delayed:  Previously, ODM shared plans to begin a 10% reduction in payments in the summer of 2021 for claims that cannot be matched to visits in the EVV system.  These payment reductions are delayed until January 2022 or later.  ODM will use this time to help providers become successful with EVV.
• ODM will begin sharing how providers are doing with supporting claims with billing.  They will send the emails to providers in groups, based on their success in supporting claims with visits in EVV.  See the schedule and sample letter.  

 

Buckeye’s Provider Accessibility Initiative

Buckeye is working to remove barriers our members may have accessing provider locations. We want to enable our members to view provider location’s disability access information so they can find a provider based on their own disability access needs. For this initiative to work, we need to hear from you.

 

New MyCare (MMP) Waiver Services Letter

To make working with Buckeye as easy as possible we have created a team and a streamlined process to document and close any gaps in waiver services. You may begin seeing a new form delivered to you outlining the member, gaps in their services and the name and person you can call to resolve the issues. We hope this makes the documentation process easier. If you have questions, please call Provider Services.

 

Reduced Prior Authorization Requirements

In response to your feedback, Buckeye has removed 25 services from our prior authorization list and 22 services from the Ambetter prior authorizaton list effective March 31, 2021. 

Welcome to the February 2021 Provider Update Newsletter

 

COVID Vaccine Updates

• See our new Medicaid COVID Vaccine page with the latest information.
• Be sure your patients know about the upcoming ODH webinars, starting February 22.
• Ohio has over 700 providers across all 88 counties to ensure access close to home. Buckeye’s partnership with Federally Qualified Health Centers and nursing homes, as well as personalized outreach to members, add up to Ohio COVID Champions.

 

Don't Miss Anything - Sign Up for Provider Communications

Whether you are an office manager, clinical staff, physician, billing or front desk worker, or serve in another role within our provider locations, Buckeye would like to share relevant, timely information that makes it easier to do business with us. Please sign up for Provider Communications. Even if you have received our email communications in the past, please sign up for future communications.

 

CMS Removes Inpatient Only List Starting in 2021
Medicare Only – Allwell and MyCare

CMS has announced the finalization of their rule to end the inpatient-only list. This transition will occur over a three-year period and begins by eliminating about 300 services, mostly musculoskeletal-related in nature (including joint replacements). See the details.

 

Navigating the process for hospital level of care approval and denials.

A Step-by-Step Guide.

To assist you in navigating the process of receiving approval or denial for the level of care you request for admission to a hospital, long-term acute care facilities, rehabilitation facilities and skilled nursing facilities, we created this Step-by-Step Guide.
 

Q1 2021 CPC Payments Mailed Week of 2-8-21

The first quarter 2021 Comprehensive Primary Care payments, reflecting attribution from third quarter 2020, were mailed to the applicable providers the week of 2-8.

If you have not yet received it, please check to see if your postal address is current in MITS.  

 

National Eating Disorder Awareness Week - February 22-28, 2021

Though most commonly associated with women, eating disorders can impact people of all genders, ages, race, ethnicities and body shapes. They can onset from biological, as well as psychological factors. To better understand these disorders, read our February article. 
 

EVV Training

The Ohio Department of Medicaid (ODM) webinars:

• February: General EVV Q/A
  
• March: Overview and Updates for Case Manager
  

See details.

 

HEDIS Measure Deep Dive: Appropriate Treatment for Upper Respiratory Infection

Typically, antibiotics are not recommended for upper respiratory infection, as these are usually viral in nature. Research has shown...See Details

Growth Opportunities & Resources for Teens

Buckeye Health Plan provides growth opportunities and resources to support the healthy development of young people ages 13 – 19 years old through Centene’s industry leading, national initiative, Strong Youth Strong Communities (SYSC℠). SYSC partners with the Pro Football Hall of Fame and other national youth serving organizations to offer in person and virtual summits covering topics such as:

• Stay Smart: education and career development;
• Stay Safe: cyber safety and healthy relationship skills;
• Stay Paid: financial literacy;
• Stay Ahead: leadership development; and
• Stay Well: supports for mental and physical health and wellness.

These resources and more, including videos of virtual SYSC summits, are now available on the SYSC website and mobile apps. 

 

2021 CPT Code and Guideline Changes for Office/Outpatient Visits - Medicare Only

The New Year has ushered in notable changes for evaluation and management (E/M) services that will impact most, if not all, providers. Designed to reduce physicians’ administrative burden and facilitate increased time with patients, these changes, with respect to office/outpatient evaluation and management (E/M) services, are as follows:

I. CPT Code Changes

A. CPT code 99201 has been deleted

B. Code titles for CPT codes 99202-99215 have been revised. References to the history and exam as required components for service level selection have been removed and replaced with instructions to document “a medically appropriate history and/or examination.” 

II. Changes to Service Level Selection

• The level of service is now selected based on medical decision making or time. Medical decision making (MDM), a familiar concept for providers, has seen the implementation of a few changes meant to shift focus toward tasks that affect patient management. Meanwhile, the guidelines for using time to level an office/outpatient visit have changed to a significant degree.

1. Firstly time can now be used to level all office/outpatient visits; counseling/coordination of care no longer has to dominate the encounter.

2. Secondly providers’ total time on the day of the encounter now determines the service level, not just face-to-face time with the patient. Examples of non-face-to-face time include time providers spend performing activities such as reviewing patient tests; ordering medications, tests, or procedures; referring and communicating with other health care professionals; and documenting clinical information in the health record.

3. Lastly the typical time associated with a code is now redefined in terms of ranges of minutes.

While the history and exam do not impact the level of service in 2021, neither should be eliminated altogether from 2021 progress notes. CMS has offered some guidance, stating, “It remains our expectation that practitioners will document E/M visits as necessary to ensure quality and continuity of care.”

Welcome to the January 2021 Provider Update Newsletter

Happy New Year!

Buckeye hopes you and your families had a safe and enjoyable holiday season. We look forward to working with you in 2021 to continue building our partnership and make working with us as easy as possible. We welcome any thoughts or ideas you have to help us help you, please feel free to let us know.

Provider Communication Sign-up Form

Whether you are an office manager, clinical staff, physician, billing or front desk worker, or serve in another role within our provider locations, Buckeye would like to share relevant, timely information that makes it easier to do business with us. Please sign up for Provider Communications. Even if you have received our email communications in the past, please sign up for future communications.

ODM January 2021 EVV Training – Home Care Providers

As of January 1, 2021, all providers who are providing Phase 3 EVV-eligible services must be using EVV. Phase 3 includes self-directed services and other services necessary to meet the requirements of the Cures Act. See more details and register for training.

Phase 3 training was required by December 31, 2020. However, the Ohio Department of Medicaid (ODM) and Sandata are hosting Electronic Visit Verification (EVV) webinars in January 2021. The webinars will focus on best practices related to EVV maintenance and ensuring visits are accurately captured to support claims. Please use the links below to register. After registering, you will receive a confirmation email containing information on joining the webinars. If you are unable to attend a live webinar, a recording will be posted to the Webinar tab on the ODM website after the first hosted webinar. 

Be Successful with EVV

• January 26, 2021, 3:00 to 4:30 p.m. Register
• January 29, 2021, 2:30 to 4:00 p.m. Register

New Feature: Behavioral Health Video Series

Each month during 2021 we will feature an aspect of Behavioral Health in our Provider Update newsletter. The information is intended to help you help your patients. These will include a video from Dr. Pelt, Buckeye Health Plan BH Medical Director and may also include articles and/or other materials to support our providers.

January is highlighting Substance Use Disorder. We are pleased to share a video from Dr. Pelt and a helpful article on how Buckeye is addressing the opiate crisis. 

In addition, we are sponsoring free training on The Treatment of Opioid Use Disorder delivered by ASAM. This 2 part course:

• covers all medications and treatments for opioid use disorder
• provides 8 hours of required education needed to obtain the waiver to prescribe buprenorphine in an office-based setting.
• qualifies for CEU credits

Part 1: Online course due: February 4
Part 2: Virtual Live 4 hour Course on February 5

Register today for this free training!

Diabetes Self-Management Education Program is now covered by Buckeye Health Plan for Medicaid members

The DSME program can create positive changes in health behaviors and improve diabetes-related outcomes such as: hemoglobin A1C levels, BP, Cholesterol. It also results in healthier lifestyle behaviors and fewer hospital admissions and readmissions. See more details.

Buckeye Care Management Team Leads With Heart

Buckeye’s Vision is to transform the health of the community, one person at a time. It guides our care management team as they work with members, like Brian, who have complex physical and mental health conditions. Thanks to Buckeye, Brian is managing his conditions and actively enjoying the art and music he loves.

Watch the video to learn more about Brian’s health journey.

You are an important part of the team that surrounds and supports Buckeye members. We are grateful for your partnership. 

Talking to Your Patients About the COVID-19 Vaccine

Patients look to their healthcare professionals for medical guidance and assurance about the COVID-19 vaccine. Effective engagement can occur during an in-person office visit, through messages on your patient portal, or at a telemedicine appointment. Patients trust in their providers to help guide healthcare decisions, and your strong vaccine recommendation is the most important part of the conversation.

It may be helpful to refer your patients to the links below to help them understand that the COVID-19 vaccine is safe, effective and provided free of charge.

Coronavirus.ohio.gov
Centers for Disease Control and Prevention

In addition, we maintain a provider COVID section on our website. You can find billing information, talking points, FAQs and the latest information. Thank you for your partnership in keeping our members, your patients, safe. Together we can stop the spread.

 

Welcome to the December 2020 Provider Update Newsletter

Wishing You a Happy and Safe Holiday Season

As we put 2020 in our rear-view mirror, Buckeye would like to recognize and thank our providers for the extra care and service you’ve given as many of our members struggled to meet basic needs in addition to maintaining their health during this unprecedented year. Thank you for partnering with Buckeye on many initiatives that went beyond healthcare. We are grateful that together, we have built a safety net that helped support our members during tough times.

Buckeye Leads with Heart in everything we do and remains focused on our core values of compassion, connection authenticity and accountability. This starts at the top with our President and CEO Steve Province, and extends through all aspects of the company. Steve shares a brief thank you message on behalf of all of Team Buckeye.

Holiday Hours

Our Provider Services is open every weekday from 8 a.m. to 5 p.m. throughout the holidays, except: 12-25-20 and 1-1-20. 

Holiday Check Runs

• CBH-Checks issued Tuesday December 22 for  the week of Christmas
  CBH-Check issued Tuesday December 29 for the week of New Year’s
• Medicare-Checks issued Tuesday December 22 for  the week of Christmas
  Medicare-Check issued Tuesday December 29 for the week of New Year’s
• Medicaid (no changes)

Provider Communication Sign-up Form

Whether you are an office manager, clinical staff, physician, billing or front desk worker, or serve in another role within our provider locations, Buckeye would like to share relevant, timely information that makes it easier to do business with us. Please sign up for Provider Communications. Even if you have received our email communications in the past, please sign up for future communications.

COVID-19 Updates

• Prior Authorizations: To reduce barriers to care and reduce administrative burden for providers caring for our Buckeye Medicaid, MyCare, Medicare and Ambetter members, we have made many changes to our prior authorization policies. Be sure you see the latest.
• COVID Vaccine Billing: Buckeye Health Plan is closely following advancements in the prevention and treatment of COVID-19, including vaccinations. As a healthcare provider, you will play an integral role as COVID-19 vaccines become available. Please see our update on important new information about vaccine coverage for Medicaid, Medicare and Ambetter.
• COVID Vaccine Provider Talking Points - How you can engage and inform in a meaningful way:  Patients look to their healthcare professionals for medical guidance and assurance, and while much is still unknown, you can start laying the groundwork now for when the vaccines are available. 
  

Mental Health During the Holidays - Tips to Share With Older Patients  

Buckeye is raising awareness about the mental health challenges that many older adults face this holiday season. We ask you to offer encouragement to older adults to help them cope during this challenging time of isolation required by COVID safety measures. Here are signs of declining mental health and tips to share about how to stay healthy:

Signs that mental health may be deteriorating:

• Deep boredom, general lack of interest and withdrawal
• Losing interest in personal hygiene
• Poor eating habits and nutrition
• Significant disrepair, clutter and hoarding at home

Ways to stay healthy:

• Call, text or video chat with family and friends often
• Exercise, as physical activity – it’s good for body and mind
• Read a book or play games to keep your mind fresh
• Cook healthy dinners and share recipes online with family and friends
• Catch up on a TV series or watch an upllifting movie

If someone is experiencing depression or other mental health issues – especially during the holidays when so many others are feeling joyous, it’s important that they acknowledge those feelings and reach out for support. Let them know that help is readily available:

• Talk to their doctor
• Call the Substance Abuse and Mental Health Services Administration (SAMHSA) hotline at 1-800-662-HELP (4357).
• Access Buckeye’s free online tool called Buckeye Community Connect to quickly and easily find free or low-cost resources and services by zip code for mental health services and medical care, food, housing, transportation and much more.
• Buckeye offers a behavioral health crisis line and telehealth services to support members' needs. Call 1-866-246-4358 and press * to be connected to a behavioral health specialist.

Announcing a 2021 Behavioral Health Video Series

Buckeye will launch a new video series to supplement our newsletter focus on Behavioral Health. Each video will be about three minutes long and will address important topics such as: bullying, social isolation/social inclusion, eating disorders, Autism, PTSD, senior mental health awareness and anxiety disorders.

Look for our first video in our January 2021 Provider Update Newsletter.

Pediatric ECHO Seminars

Starting in January 2021, Buckeye is partnering with Nationwide Children’s Hospital to offer healthcare professional access to two new Project ECHO seminars:

• Primary Care: Foundations Series
• Advanced Series: ADHD in Primary Care

To register and more details go to their website.   

For any questions, please email ProjectEcho@nationwidechildrens.org directly.

What is Project ECHO?

• Project ECHO is a learning collaborative that helps healthcare professionals acquire skills to manage children with behavioral health conditions presenting in primary care office.
• This interactive, case-based learning is focused and didactic. 
• It is held during the lunch hour and provides opportunity to earn CME credits.
• The program will present cases and invite questions to the interdisciplinary team (Hub) and other primary care providers (Participants) via video conferencing (Zoom)

Why Child Behavioral Health ECHO?

• There is a critical shortage of Behavioral Health specialists
• Children often talk with their primary care provider for help with behavioral health
• We aim to support and enhance the capacity of primary care providers through collaboration with experts and collective wisdom of the primary care community

What to expect during an ECHO session

• Participate in a 60-minute session (4 sessions)
• Scheduled to meet on Thursdays between 12 and 1 PM 
• Submit a case to present to the group and engage in interactive discussion
• Collaborate with the expert team in providing recommendations

Ambetter 2021 Expansion

Buckeye’s Marketplace Exchange health plan, Ambetter, will be available for members in 27 additional Ohio counties for 2021. Ambetter delivers the high quality, comprehensive coverage that your patients deserve. This coverage offers valuable programs and educational tools for your patients, making it easier for them to stay in charge of their health. We look forward to partnering with you to improve the healthcare outcomes of our members.

You can see our Ambetter expansion counties on our Ambetter Plans on the website. If you have already joined the Ambetter network and would like to participate in an Instructor-Led Orientation, please see our Training page.  These one-hour webinars discuss the Ambetter plan, claims, authorizations, web access, reference materials and key contacts at Buckeye Health Plan.

If you have any questions, please contact Provider Services.

Introducing Buckeye’s Provider Accessibility Initiative

Buckeye is working to remove barriers our members may have accessing provider locations. We want to enable our members to view provider location’s disability access information so they can find a provider based on their own disability access needs. For this initiative to work, we need to hear from you.

Member Transportation Benefit Includes Access to Food

Buckeye offers member transportation, at no cost to them, that help members get to medical, dental and vision appointment. Did you know they also provide transportation for non-medical reasons, such as access to food?  See more details and other non-medical reasons.

Practitioners & Groups Must Enroll with ODM Prior to January 2021.

All providers who currently contract with or wish to contract with a Medicaid managed care plan (MCP) must be enrolled with the Ohio Department of Medicaid (ODM) prior to January 2021 or your claims will deny. This includes any practitioner or group practice that bills for or renders services. ODM requires professional medical groups to be enrolled as outlined in their memo.

Important EVV Reminder – Phase 3 Training Required 
by December 31, 2020

As of January 1, 2021, all providers who are providing Phase 3 EVV-eligible services must be using EVV. Phase 3 includes self-directed services and other services necessary to meet the requirements of the Cures Act. 

The Ohio Department of Medicaid (ODM) is implementing Electronic Visit Verification (EVV) for some home and community-based services in response to federal requirements set forth in the 21st Century Cures Act (Cures Act). EVV is an electronic system that verifies key information about the services provided. In accordance with the Cures Act, the system implemented by ODM will record the date of the service, the time the service started and ended, the individual receiving the service, the person providing the service and the location of the service. Both agencies and non-agency providers are impacted by EVV.

As of January 1, 2021, all providers who are providing Phase 3 EVV-eligible services must be using EVV. A full listing of the services can be found on the Phases tab on the below link.

Medicaid Initiatives - EVV Phases

Also, please see sections on the link for Individual and Provider training.

 

Welcome to the November 2020 Provider Update Newsletter

Thank you for all you do!

In this season of giving thanks, Buckeye would like to thank our valued providers for the exceptional care you give our members. We appreciate your partnership in delivering high-quality and compassionate care for the best possible outcomes. We wish you and your families a safe and enjoyable holiday.

Holiday Hours

Our Provider Services will be closed Thursday and Friday, November 26 and 27, 2020 in observance of the Thanksgiving holiday. Please let us know if you have any questions.

Provider Communication Sign-up Form

Whether you are an office manager, clinical staff, physician, billing or front desk worker, or serve in another role within our provider locations, Buckeye would like to share relevant, timely information that makes it easier to do business with us. Please sign up for Provider Communications. Even if you have received our email communications in the past, please sign up for future communications.

Flu Shot Reminder: You can make a difference! Help your patients get their flu shot.

• Make a strong recommendation to your patients to get their flu shot. Research shows that patients are more likely to get a flu shot if their doctor recommends it.
• Follow-up is important! Talk to your patients about where and when they’ll get their flu shot, and make a note to confirm during their next visit.
• Talk with your patient about any questions or concerns — and be sure to repeat your strong recommendation. Most people know the flu shot is important. They may just need your reminder!

See our Fluvention page on our website for more details and Talking Points.

Ambetter 2021 Expansion

Buckeye’s Marketplace Exchange health plan, Ambetter, will be available for members in 27 additional Ohio counties for 2021. Ambetter delivers the high quality, comprehensive coverage that your patients deserve. This coverage offers valuable programs and educational tools for your patients, making it easier for them to stay in charge of their health. We look forward to partnering with you to improve the healthcare outcomes of our members.

You can see our Ambetter expansion counties on our Ambetter Plans on the website. If you have already joined the Ambetter network and would like to participate in an Instructor-Led Orientation, please see our Training page.  These one-hour webinars discuss the Ambetter plan, claims, authorizations, web access, reference materials and key contacts at Buckeye Health Plan.

If you have any questions, please contact Provider Services.

Utilization Management Updates 

1. PA Authorization requirements changes for long term acute care facilities (LTAC), skilled nursing facilities (SNF) and inpatient rehabilitation facilities (IRF hospital). Link will take them to content below.
2. Re-routing calls to better support our providers.
   Delivering the best possible customer service for our providers is a top priority for Buckeye. During this unprecedented pandemic time we are experiencing a significant increase in calls regarding our authorization requests. Therefore, our UM and Provider Service (PS) departments have combined forces to best meet your needs.

UM will continue to take the calls listed below:
-- Authorization date changes that cannot be faxed
-- Authorization needed that was initiated by Emergency Room visit
-- Questions regarding additional clinical information for a request for service
-- Questions about a denial

UM Department: 1-866 246-4359 M-F, 8 a.m. to noon and 1 to 5:00 p.m. (closed noon to 1:00 p.m.)

Our Provider Services representatives are standing by to assist you with the following calls:
-- To start or check an authorization*
-- Authorization status checks
-- Requesting a care manager
-- Appeal status or questions
-- Assistance with our online Prior Auth Code Check Tool*
-- Provider portal questions
-- Claims*
-- Member benefits*

Provider Services: 1-866-296-8731 M-F, 8 a.m. to noon and 1 to 5:00 p.m. (closed noon to 1:00 p.m.)

* Self-Service tools on our provider portal.

Warm transfers between UM and Provider Services will be provided, as needed. We hope this change will help us to quickly address the needs of our providers.

       3. Medicare 2021 Prior Authorization List has been posted to the
           Prior Authorization page of our website.

Introducing Buckeye’s Provider Accessibility Initiative

Buckeye is working to remove barriers our members may have accessing provider locations. We want to enable our members to view provider location’s disability access information so they can find a provider based on their own disability access needs. For this initiative to work, we need to hear from you.

Member Transportation Benefit Includes Access to Food

Buckeye offers member transportation, at no cost to them, that help members get to medical, dental and vision appointment. Did you know they also provide transportation for non-medical reasons, such as access to food?  See more details and other non-medical reasons.

Buckeye Health Plan Raises Awareness for Breast Cancer

Breast cancer is the second most common cause of cancer-related death for Ohio women. But when it’s detected early, most breast cancer can be treated successfully. We encourage age appropriate mammograms and Buckeye can make access easier. Download a Mammogram Infographic for your patients.

Practitioners & Groups Must Enroll with ODM Prior to January 2021.

All providers who currently contract with or wish to contract with a Medicaid managed care plan (MCP) must be enrolled with the Ohio Department of Medicaid (ODM) prior to January 2021 or your claims will deny. This includes any practitioner or group practice that bills for or renders services. ODM requires professional medical groups to be enrolled as outlined in their memo.

New Patient/Client Liability Reconciliation Form

We strive to find ways to make working with Buckeye Health Plan easier. To assist in the reporting of PL errors or discrepancies for claims paid by Buckeye Health Plan we have created an easy to use Reconciliation Form and instructions for your use.

Important EVV Reminder – Phase 3 Training Required
by December 31, 2020

As of January 1, 2021, all providers who are providing Phase 3 EVV-eligible services must be using EVV. Phase 3 includes self-directed services and other services necessary to meet the requirements of the Cures Act. 

The Ohio Department of Medicaid (ODM) is implementing Electronic Visit Verification (EVV) for some home and community-based services in response to federal requirements set forth in the 21st Century Cures Act (Cures Act). EVV is an electronic system that verifies key information about the services provided. In accordance with the Cures Act, the system implemented by ODM will record the date of the service, the time the service started and ended, the individual receiving the service, the person providing the service and the location of the service. Both agencies and non-agency providers are impacted by EVV.

As of January 1, 2021, all providers who are providing Phase 3 EVV-eligible services must be using EVV. A full listing of the services can be found on the Phases tab on the below link.

Medicaid Initiatives - EVV Phases

Also, please see sections on the link for Individual and Provider training.

Enhancements to Claims Payment Processes

You asked and we listened. We received requests from providers for Negative Balance Reports to assist in reconciling your accounts. Now, providers will be able to identify from which payment the Negative Balance was carried forward.

Prior to Oct. 23, 2020, the Provider Level Adjustment (PLB) did not provide sufficient information for you to auto-post remittance advices (explanations of payment in electronic format) also known as 835s.

• We have made an enhancement of the Forwarding Balance within the 835 PLB segment to include the trace number of the Negative Balance to allow you to auto-post Negative Balance 835s.
• In addition, Offsets within the 835 now contain the patient control number and the provider’s patient account number to allow you to auto-post an Offset to your balance.
  

These enhancements will significantly reduce issues with Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT), and increases provider self-service. You will no longer need to request Negative Balance reports in order to auto-post an ERA.

Please note: These enhancements do not apply to Negative Balances and Offsets prior to Oct. 23, 2020.

Welcome to the October Buckeye Provider Update Newsletter

We believe that communication is vital to a successful partnership and our goal is to establish a plan to communicate essential information to make working with Buckeye easier. For easy access and reference, we’ll store the communications in the Provider Communications page of our website.

To help streamline the number of communications and better categorize the information for your use, we will be introducing new provider communication categories over the next few months.

• Provider Update Newsletter: delivered on a monthly basis, this will be latest in operational changes, processes and procedures. We’ll also throw in some strategic initiatives and opportunities for you to partner with Buckeye.
• Provider Notices: specific notices from ODM, CMS or Buckeye operations/policies that you need to know, but can’t wait for the newsletter.
• Provider Alerts: urgent information that needs immediate reporting to our valued providers.
• Special Announcements: positive information worthy of creating a spotlight to showcase exciting company and community-based activities.

Our hope is that you find these communications both helpful and easy to use. We want to make your job easier, so we welcome your feedback and suggestions and look forward to connecting with you!

Provider Update Newsletter Sign-up Form

Whether you are an office manager, clinical staff, physician, billing or front desk worker, or serve in another role within our provider locations, Buckeye would like to share relevant, timely information that makes it easier to do business with us and partner together in service to our members and communities. Please go to our Provider Communications Sign-Up Form and let us know if you have questions. Even if you have received our communications via email in the past, please sign up for future communications. We’ve gathered email addresses from various resources, but may not have your other information we need to customize specific messages in future communications.

HEDIS - Q4 Targeted Measures

COVID-19 continues to impact our members and providers. We are seeing significant declines in the number of members who are making preventative care appointments with their PCPs.  We need your help to close all 2020 gaps in care. Please review your patient records and contact Buckeye members who have missed appointments – particularly those who are not compliant on HEDIS-related measures. Buckeye is here to help. Remind them we offer:

• Transportation to and from provider offices for well-care and treatment; and trips to the pharmacy for medications.
• No-cost telehealth visits for patients who may have transportation or health related barriers to making an in-person visit.

Your Buckeye provider representative is here to help you identify ways to reach members and close care gaps. If you are unsure who your representative is, please contact Provider Services at 866-296-8731.

Targeted HEDIS measures for Q4 2020. You can find the full descriptions on our website:

• Breast Cancer Screening
• Cervical Cancer Screening
• Post-Partum Care
• Adult Access
• Child Access
• Immunizations
• Annual Dental Visit
• Comprehensive Diabetes Care:  HbA1c (Poor Control, Testing), Eye Exams, Blood Pressure
• APM, SMC, SMD, SDD
• COA, COL, PCR, MDS

We value our partnership and thank you for your continued support.

New COVID-19 Telehealth Guidelines

In order to ensure that all Ohio Medicaid members have needed access to care, the Ohio Department of Medicaid (ODM) and Medicaid Managed Care Plans (MCPs) are increasing the scope and scale of reimbursement for telehealth services for Medicaid recipients during the duration of the COVID-19 emergency. These coverage expansions will benefit not only members who have contracted or been exposed to the novel coronavirus, but also those members who need to seek care unrelated to COVID-19 and wish to reduce their exposure in public settings. Through collaboration with providers and ODM, the short-term goal of the MCPs is to expand access to critical patient care through the time of emergency, with the overarching goal of creating a future state centered on sustainability and person-centered quality metrics. See the MCP Telehealth Policy and Provider Telehealth Resource Guide.

A network that provides seamless COVID-19 care for your patients.

LOB: Marketplace and Medicaid PCPs
The COVID-19 global pandemic has created unprecedented changes to our lives and healthcare systems. While we continue to connect our members to COVID-19 services, we want to reach out to our provider partners on how we can work together to better support their care needs. As a primary care physician (PCP), you are at the heart of our members’ healthcare. They trust and rely on you See More

October is Mental Health & Breast Cancer Awareness Month

Mental Health Awareness

 

Each year, millions of Americans face the reality of living with a mental health condition. However, mental illness affects everyone directly or indirectly through family, friends or coworkers. Despite mental illnesses’ reach and prevalence, stigma and misunderstanding are also, unfortunately, widespread (NAMI, 2020). Read: The Impact of Stigma on Substance Use Disorders

Buckeye Encourages Breast Cancer Screenings During National Awareness Month

In honor of Breast Cancer Awareness Month, Buckeye is encouraging Ohioans to get their breast cancer screenings. Because some Ohioans may fear exposure to COVID-19 by visiting their doctor, it’s important for physicians offices to reach out to patients and encourage them to get this important screening. “Getting a mammogram has never been faster or easier,” said Dr. Brad Lucas, Buckeye’s chief medical officer. “It takes 30 minutes or less and can give your patient peace of mind.”

Flu Prevention: You can help stop the flu!

Strongly recommend to all of your patients to get their annual flu shot.

You have a key role to play in recommending that your patients get the flu shot.  Buckeye Health Plan is here to help. See our Fluvention Campaign page here.

Important events and educational offerings from ODM and our partners:

ODM

As you may know, efforts are underway to assist providers in becoming fully compliant with Ohio’s EVV requirements. The webinars scheduled for October and November are part of that effort.

Auto-verification of visits occurs when no provider action is necessary after the visit is recorded at the time of service. All required information is captured and no exceptions are posted.  Join us at one of the following webinars to learn more about auto-verification, why exceptions post to your visits, and how to achieve auto-verification of your visits.

Webinar (Link)                    Date/Time                                         

Streamlining EVV Workflow    Tuesday, October 27, 2020, 3:30pm – 4:30pm EST      

Streamlining EVV Workflow    Tuesday, November 3, 2020, 2:30pm – 3:30pm EST 

Streamlining EVV Workflow    Friday, November 6, 2020, 10:00pm – 11:00pm EST 

Please share this information with others who may be interested or benefit from the webinars.

OAAP 

Free Virtual Event:
2020 Reversing the Trend of Irreversible Actions - Store It Safe Virtual Fundraiser
November 20th: 11:30 AM-1:00 PM

Interdisciplinary panel on teen suicide prevention -- Featuring Injury Prevention Medical Directors Dr. Mike Gittelman and Dr. Sarah Denny plus Denise Meine-Graham from Franklin County Loss. Also back this year, due to overwhelming requests from former attendees, is teen advocate, Jeremy Hardjono!

This message is so important and timely that we have decided to make the event FREE for all to attend.  It is essential that we all learn more about teen mental health and safe storage practices to prevent suicide. Register here. While you’re there, check out the Buckeye Health Plan Virtual Exhibit.

Ohio AAP is now offering LIVE VIRTUAL versions of in-office MOBI & TIES!

These enhanced trainings offer the same content as our traditional MOBI & TIES, while also adding in COVID-19 information, with a focus on provider and practice guidance during and post-pandemic. 

Our virtual MOBI & TIES include:

• Guidance on continuing immunization best practices
• Epidemiology & background of COVID-19
• Practice operation guidance in a pandemic (i.e. telehealth)
• 1-hour CME for each session

Please contact Lory Sheeran Winland, Director of Immunization Programs, at lwinland@ohioaap.org to request a live virtual MOBI and/or TIES.

Nationwide Children’s Hospital (NCH)

Project ECHO – Advanced Series: Eating Disorders in Primary Care (register by 10-26)
October 29: Noon to 1:00 p.m., Prevention and Identification of Eating Disorders in Primary Care

November 12: Recognize and Refer Eating Disorders in Primary Care

• Learn to differentiate between eating disorders
• Learn preventative measures for use within your practice
• Understand assessment and treatment options in primary care setting
• Compile resources and referral information to your practice and patients

For more details and to register by October 26

Project ECHO – Advanced Series (2 parts): Gender Dysphoria in Primary Care
November 5: Noon to 1:00 p.m.  Emotional and Behavioral Health of Today’s Genderation ” of Children and Adolescents: The Role of the Pediatrician and Primary Care Providers

November 19: Gender Affirming Medical Care

• Learn relevant terminology with respect to gender and sexuality constructs
• Learn ways to create a welcoming office environment for gender diverse patients and families
• Understand non-medical and medical options for treatment
• Compile resources and referral information for your practice and patients

For more details and to register by November 3

New Opioid Program

As part of the initiative to combat the opioid epidemic, Buckeye Health Plan has adopted a Drug Management Program (DMP) for beneficiaries at-risk for misuse or abuse of frequently abused medications. Learn more about Use of Opioids from Multiple Providers.

Partnership with Mercy Health Overcomes COVID Barriers to Preventive Health Checks

Challenge: Encourage Buckeye members who have chronic health conditions to complete their annual preventative visit with their PCP.  Read about our successful outcome!

Good News for our Ambetter OB/GYNs

In our goal to make working with us easier, we’re pleased to announce that Buckeye has removed the PA requirements for OB-Ultrasound. As of September 24, 2020, participating OB/GYNs will no longer need to submit an OB prior authorization for OB-Ultrasounds. Non-participating providers must continue to submit the prior authorization and receive approval before services are rendered.

Buckeye Partners With Lower Lights CHC to Pilot New Healthy Food Rx Program

Did you know that Buckeye partners with providers across Ohio to offer programs that help our members overcome obstacles to care and social determinants of health?  In 2020, we partnered with Lower Lights Christian Healthcare Center, an FQHC in urban Columbus, to successfully pilot a Healthy Food Rx program for adult Medicaid members who have chronic health condition. The program provides nutrition education and healthy food each month. We are looking to expand our program in 2021. Read more details, see an inspiring video journal and let us know if you’d like to partner with us next year.

Buckeye Cares for the Whole Person

Medical care is a top priority, but at Buckeye we work to meet the many needs that may impact our member’s ability to access that care. We want to ensure services are provided that meet the needs of the whole person. Check out our programs that go the extra mile to care for our members.  

BH Utilization Management - When to use ASAM

As announced by Ohio Department of Medicaid, they have a new requirement to ensure clinical consistency and coverage of Medicaid services across the full ASAM continuum. To make things easier, Buckeye has summarized the new requirement and created a form to help guide you.